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1
Singh, Prashant. "MATHEMATICAL DESIGN OF THE VOLAR SURFACE OF THE RADIUS." University of Akron / OhioLINK, 2006. http://rave.ohiolink.edu/etdc/view?acc_num=akron1154719475.
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Scheer, Johan. "Periulnar Injuries Associated with Distal Radius Fractures." Doctoral thesis, Linköpings universitet, Ortopedi och idrottsmedicin, 2011. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-67998.
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Residual dysfunction after a fracture of the distal radius is most often mild but may give rise to significant impairment especially in the younger active population. The symptoms often manifest around the distal ulna when loading the hand or rotating the forearm. In this region are found articular and soft tissue connections running from the distal ulna to the distal radius as well as to the ulnar side of the carpus. The aims of this thesis were to investigate the effects of distal radius fractures on the structures about the distal ulna and to what extent malunion and ulnar soft tissue lesions affect function. Both patients and cadaver specimens were used in the five different studies. In a retrospective study of 17 malunited distal radius fractures supination impairment improved significantly by correction of the skeletal malunion. This highlights the importance of distal radioulnar joint congruity for forearm rotation in a subset of cases. The pathomechanisms of injury to the triangular fibrocartilage complex (TFCC) were studied. In a cadaveric distal radius fracture model different restraining properties and injury patterns were investigated. Similar patterns of injury were then observed in 20 patients with a displaced distal radius fracture. It was found that a TFCC injury can be expected with dorsal displacement of the distal radius fragment of 32o or more from the anatomically correct position. The distribution of a TFCC injury apparently differs depending on the size of an associated ulnar styloid fracture. In cases of an intact ulnar styloid or a concomitant tip fracture (Type 1) the first stage of injury seems to be extensor carpi ulnaris subsheath separation from the distal ulna and the dorsal radioulnar ligament. Thereafter follows a disruption of the deep insertions into the fovea of the ulna starting from the palmar and extending dorsally and radially. An extensive injury can be detected with a novel non-invasive test called the ‘bald ulnar head test’, which is performed under anaesthesia. Diagnosis of an acute TFCC injury is difficult using non-invasive methods. In a prospective study of 48 patients, CT scanning to detect pathologic subluxation was found to be of little use in both acute and chronic cases, and is therefore not endorsed on this indication. A radioulnar stress test, which in previous studies has correlated well to a deep TFCC injury, was found to be highly reliable but not to correspond with significant disability in self-administered questionnaires of functional outcome two years or more after injury. This indicates that the subset of patients possibly benefiting from acute repair must be identified by other means.
3
Friedel, Andre. "Komplikationshäufigkeit bei distalen Radiusfrakturen, Evaluation therapierelevanter Faktoren." Doctoral thesis, Universitätsbibliothek Leipzig, 2011. http://nbn-resolving.de/urn:nbn:de:bsz:15-qucosa-65727.
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Die vorliegende Arbeit befasst sich mit therapierelevanten Faktoren bei distalen Radiusfrakturen. Auf der Grundlage der nach AO klassifizierten, distalen Radiusfrakturen werden sowohl verletzungsbedingte, als auch therapiebedingte Einflußfaktoren hinsichtlich des klinisch-radiologischen Ergebnisses untersucht.
Es erfolgt die Darstellung der Komplikationshäufigkeit
bei operativ und konservativ versorgten distalen Radiusfrakturen. Diese wird in Zusammenhang mit unfall-und patientenbezogenen Faktoren, Begleitverletzungen und therapiebezogenen
Einflußfaktoren untersucht und am klinisch-radiologischen Ergebnis gemessen.
Zur Objektivierung der klinisch-radiologischen Nachuntersuchung dienen der DASH-Score, der Gartland und Werley-Score (modifiziert nach Sarmiento) und der Stewart Score.
4
Croitoru, Haniel. "3D computer-assisted preoperative planning for distal radius osteotomies." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1999. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape7/PQDD_0005/MQ42603.pdf.
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Mackenney, P. J. "Distal radius fracture : epidemiology, outcome, and prediction of instability." Thesis, University of Edinburgh, 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.654287.
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The studies in the thesis are divided into two broad sections. The first section is descriptive. Data were collected prospectively over a five-and-one-half year period for approximately 4000 fractures. Validation of the data is performed. The data are used to describe the epidemiology of the fracture in the Lothian Region, and the anatomical outcome of the fracture. Multiple logistic regression analysis of the data is performed to identify those factors (recordable at patient presentation) that are prognostic of outcome. The statistical method used provides weighted significance for each of these factors, and thus mathematical formulae predictive of outcomes are constructable. A number of formulae are produced, depending on the displacement of the fracture at presentation (minimally displaced or displaced), and on the outcome measure (early and late instability, the risk of malunion, and carpal malalignment). The second section is validative. The studies in this section are an assessment of the performance of the mathematical formulae in the clinical setting. In the first study, data are collected prospectively for 139 patients, and outcomes recorded. In the second study, a group of clinicians involved in fracture management are asked to predict fracture outcome using first clinical experience and then the predictive formula. Results. The distal radius fracture occurred predominately in the older female patient following a simple fall. The fracture in this typical patient was usually unstable. The most consistently important predictors of fracture outcome were patient age, fracture displacement, comminution and ulnar variance. The mathematical formulae were able to correctly predict anatomical outcome in approximately 7/10 patients in the validative study. This was a significant improvement upon the predictive accuracy of the clinicians using experience alone. Use of the predictive formula also significantly reduced inter-observer variation in the assessment of fracture stability. Conclusion. Use of the predictive formula in the Accident and Emergency setting could improve decision-making in fracture management. By promoting an assessment of fracture stability rather than fracture displacement, appropriate management choices are facilitated. The unstable fracture can be referred for operative management, an ineffective closed reduction avoided. The thesis also demonstrates the potential value of the method employed. Multiple logistic regression analysis may provide a guide to treatment where the management of the condition is dependent upon the natural history.
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Goudie, Stuart Thomas. "Distal radius fracture : relationships between psychological factors and recovery." Thesis, University of Edinburgh, 2018. http://hdl.handle.net/1842/33253.
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Distal radius fracture is a common injury. The majority of people recover well but a proportion have ongoing pain, stiffness, deformity and functional limitation. Associations between these outcomes, injury characteristics and treatment methods are inconsistent, for example a deformed wrist is not always painful, stiff and functionally limiting. The psychological response to fracture and the role that psychological factors play in recovery are complex and poorly understood. Identification and treatment of those psychological factors that might influence disability and symptom intensity could improve outcomes in this large group of patients. The aim of this thesis is to explore the influence of psychological factors on outcome following fracture of the distal radius. To investigate these relationships further a literature review was carried out looking at the association between psychological factors and outcomes in distal radius fracture patients. Prospective studies were then performed in order to identify associations between demographic factors, injury severity, treatment and psychosocial factors and symptom intensity and disability after fracture and to identify predictors of psychological response to injury. A prospective randomised controlled trail (RCT) was then carried out to compare the impact of an additional psychological workbook intervention versus an information workbook in the otherwise routine management of distal radius fracture. The literature review identified evidence to support the association between psychological factors and outcome after acute injury in general but limited evidence specifically pertaining to distal radius fracture. The first prospective study of 216 patients found psychosocial factors to be more strongly associated with disability (Disability of Arm Shoulder and Hand score, DASH) and pain intensity after distal radius fracture than any injury or treatment factor. The second prospective study of 153 patients found that psychological traits are relatively stable in this cohort and that no demographic, injury or treatment factors were associated with the small changes in psychological scores up to 10 weeks following injury. The RCT demonstrated that use of a psychological workbook did not significantly improve disability six weeks after injury compared to an information workbook in a cohort of patients with distal radius fracture (DASH 38 vs 35, p = 0.949). The importance of psychosocial factors in recovery from distal radius fracture has been demonstrated. Following this injury, psychological factors remain stable over time or fluctuate to a small degree with distinct trends. In cohorts with stable psychological responses to fracture, the individual psychological response cannot be reliably predicted by demographic, injury or treatment factors. Use of a psychological workbook intervention does not improve outcomes in patients with a good initial psychological response to injury. Future work should investigate less psychologically stable and well adapted cohorts, establish how best to identify patients at risk of poor outcome and whether, indeed, these specific groups are amenable to treatment and if so what form this intervention should take. It should address limitations identified in this work, primarily, reduce questionnaire fatigue with more focused psychological questionnaires. Ultimately, it should work towards creating a structure where patients can be screened with a recognised psychological scoring system at initial presentation to fracture clinic and allow a sub-group of psychologically mal-adpted patients to be referred on to a dedicated psychology service, that would work to optimise the psychological conditions for recovery.
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Kikuchi, Yasuhiro. "Morphological Study of the Primates Distal Radius by using pQCT." 京都大学 (Kyoto University), 2003. http://hdl.handle.net/2433/149161.
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Addula, Venkateshwar Reddy. "FUNCTIONAL BIOMECHANICAL EVALUATION OF MULTIPLE DESIGN PROGRESSIONS OF DISTAL RADIUS VOLAR PLATES." University of Akron / OhioLINK, 2007. http://rave.ohiolink.edu/etdc/view?acc_num=akron1196715761.
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Jäger, Viktoria. "Specifik rörlighet i handled, carpalbensleder och distal underarm 6 månader efter distal radiusfraktur." Thesis, Luleå tekniska universitet, Hälsa och rehabilitering, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:ltu:diva-65556.
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Bakgrund: Distal radiusfraktur (DRF) är en vanligt förekommande fraktur med en incidens i Sverige på 31-32 per 10000 personår. Många personer upplever kvarstående besvär efter utläkt fraktur och i dagsläget saknas evidens kring optimal behandling och rehabilitering. Fler studier har konstaterat kvarstående symtom som nedsatt greppstyrka och rörlighet samt smärta. Syfte: Syftet med aktuell studie varatt undersöka specifik rörlighet 6 månader efter distal radiusfraktur. Jämförelser gjordes med andra utfallsmått på rörlighet, styrka och funktion. Metod:Utifrån en tvärsnittsdesign undersöktes 11 personer över 18 år som ådragit sig en DRF och behandlats för den under mars-maj 2016. Utfallsmått var specifik ledrörlighet testat utifrån Kaltenborns metod för ledundersökning. Detta jämfördes med uppmätt greppstyrka, angulär aktiv och passiv rörlighet samt subjektiv funktionsskattning DASH och PRWE. Sensomotorik och upplevelse av denna adresserades också. Resultat:Hos samtliga personer sågs hög grad av funktionsinskränkningar i samtliga utfallsmått, förutom hos de två av deltagarna som uppgav att de i princip var återställda. Hos dessa personer noterades inga nedsättningar i specifik ledrörlighet trots att även de hade nedsatt greppstyrka och inskränkt angulär rörlighet. Slutsats:Trots ett litet deltagarantal fanns en indikation på att specifik ledrörlighet kan vara en faktor i kvarstående funktionsinskränkning. Inget samband noterades mellan funktion, rörlighet och greppstyrka. Fler studier bör framöver utforska detta samband samt undersöka effekten av specifik behandling av rörelseinskränkningarna. Personer som ådragit sig en DRF bör följas upp närmare avseende rörelseförutsättningar och behandlingen därefter behöver vara mer specifik än idag. Här bör fysioterapeuter med utbildning inom OMT vara en självklar del i vårdkedjan.
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Challis, Murray. "Cyclic pneumatic soft tissue compression and fractures of the distal radius /." [St. Lucia, Qld.], 2004. http://www.library.uq.edu.au/pdfserve.php?image=thesisabs/absthe18485.pdf.
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Gordon, Christopher Lane. "In-vivo assessment of trabecular bone structure at the distal radius." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1997. http://www.collectionscanada.ca/obj/s4/f2/dsk2/tape16/PQDD_0012/NQ30140.pdf.
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Sirniö, K. (Kai). "Distal radius fractures:epidemiology, seasonal variation and results of palmar plate fixation." Doctoral thesis, Oulun yliopisto, 2019. http://urn.fi/urn:isbn:9789526223506.
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Abstract Distal radius fractures (DRFs) are the most commonly encountered fall-related fracture in clinical practice. Recognised as a typical fragility fractures, the ageing of the population may increase the occurrence of DRFs in the near future. The aims of this thesis were (I) to describe the epidemiology of DRFs in a cohort of adult patients in the city of Oulu during the year 2008 and to study changes in the incidence of DRFs during the last decades in Finland and other northern countries and the relationship between slippery conditions during the winter and the incidence of DRFs, (II) to compare the results of primary nonoperative treatment and early palmar plating of primarily dislocated DRFs in 80 patients ≥ 50 years old in an randomised controlled study and (III) to investigate the rate and risk factors for plate-related complications after palmar plate fixation of 881 DRFs. The crude incidence rate of DRFs was 258/100 000 person-years in Oulu in 2008, and the age-specific incidence rate in the female population aged ≥ 70 years was increased compared to previous studies in Finland and in Norway. A clear seasonal variation was observed in fall-related DRFs. The number of DRFs was 2.5 times higher on slippery winter days compared to non-winter days. Early palmar plating of DRFs showed favourable DASH (disabilities of the arm, shoulder and hand) scores at two years compared to primary nonoperative treatment. Delayed surgery in the primary nonoperative treatment group did not provide comparable DASH scores to early plating. The overall complication rate in the cohort of 881 plate-fixated DRFs was 15%. These could be regarded as plate-related in 7% of cases. Operations performed by low-volume surgeons and patient ages < 40 years were independent predictors of plate-related complications. In conclusion, the incidence of DRFs has increased during the last decades in Finland in elderly females, and slippery winter conditions increase the risk of DRFs. Early palmar plating of DRFs produces more consistent results compared to primary nonoperative treatment in patients ≥ 50 years old. The complication rate after palmar plating of DRFs is significantly influenced by surgeon experience and patient ageTiivistelmä Värttinäluun alaosan murtuma (rannemurtuma) on yleisin kaatumistapaturman aiheuttama luunmurtuma, jonka taustalla on monesti ikääntymisestä johtuva luun hauraus. Väestön edelleen ikääntyessä rannemurtumien ilmaantuvuus todennäköisesti lisääntyy. Tämän väitöskirjan tavoitteina oli (1) kuvata rannemurtumien epidemiologiaa ja ilmaantuvuuden muutosta Suomessa ja muissa Pohjoismaissa viimeisten vuosikymmenien aikana, sekä tutkia liukkaiden talvikelien yhteyttä rannemurtumien ilmaantuvuuteen. Lisäksi tavoitteena oli (2) verrata kahden eri hoitokäytännön — varhaisen levykiinnityksen ja ensisijaisen konservatiivisen hoidon — kliinisiä tuloksia ≥ 50-vuotiailla rannemurtumapotilailla. Lopuksi tavoitteena oli (3) selvittää rannemurtuman levytykseen liittyvien komplikaatioiden yleisyys sekä riskitekijät. Rannemurtumien ilmaantuvuus oli oululaisessa aikuisväestössä 258/100 000 henkilövuotta vuonna 2008. Ikä-spesifinen ilmaantuvuus lisääntyi aiempaan suomalaistutkimukseen verrattuna etenkin > 70 vuotiailla naispotilailla ja sama suuntaus todettiin myös aiemmassa norjalaistutkimuksessa. Rannemurtumien ilmaantuvuudessa todettiin selkeä vuodenaikavaihtelu, ja liukkaalla talvikelillä rannemurtuman riski oli 2.5-kertainen verrattuna ei-talvikelin murtumariskiin. Varhaisella rannemurtuman levykiinnityksellä saavutettiin paremmat DASH (Disabilities of the Arm, Shoulder, and Hand) – pisteet kahden vuoden seurannassa verrattuna ensisijaiseen konservatiiviseen hoitoon. Murtuman asennon heikentyessä seurannassa ei myöhäisleikkauksella saavutettu kliinistä hyötyä ensisijaisessa konservatiivisen hoidon ryhmässä. Komplikaatioprosentti 881 levykiinnityksellä hoidetun rannemurtumapotilaan aineistossa oli 15 %. Levytyskomplikaatioita todettiin 7 %:lla potilaista. Itsenäisiä levytyskomplikaatioille altistavia riskitekijöitä olivat kirurgin vähäinen leikkauskokemus ja potilaan matala ikä (< 40 vuotta). Yhteenvetona voidaan todeta, että rannemurtumien ilmaantuvuus on lisääntynyt Suomessa iäkkäillä naispotilailla viimeisten vuosikymmenten aikana ja liukkaudella on selkeä yhteys rannemurtumien ilmaantuvuuteen. Varhaisella leikkaushoidolla saavutetaan yhtenäisemmät hoitotulokset verrattuna ensisijaiseen konservatiiviseen hoitoon ≥ 50-vuotialla rannemurtumapotilailla. Kirurgin leikkauskokemus ja potilaan ikä ovat yhteydessä rannemurtuman levytyskomplikaatioiden riskiin
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Pickett, Alexandra. "Distal Radius Fracture : – Treatment, Complications, and Risk Factors for Re-operation." Thesis, Örebro universitet, Institutionen för medicinska vetenskaper, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-86255.
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Introduction: Distal radius fractures (DRF’s) are one of the most common types of fractures,especially in elderly women. In the last decade, there has been a shift in the treatment methodemployed for DRF’s from the traditional non-operative to an operative method using plates andscrews even though there is no evidence to suggest that this method has superior outcomes. Aim: The primary objective of this study was to identify risk factors for complications and reoperationsin the treatment of DRF’s. Method: The study was designed as a retrospective cohort study. Patients treated for DRF’sbetween 2016-2017 were included through the Swedish Fracture Register and complementedwith the patients’ charts and classification of X-Ray Images from The Orthopedic Clinic at TheCentral Hospital in Karlstad. The risk for re-operation was valued through treatment methodsand fracture classification and presented as Odds Ratio. Result: Positive ulnar variance was correlated to having an increased risk for re-operation, OR4.8 (95% CI 1.7-13.8). Those who had volar comminution in their fracture had a greater risk forre-operation, OR 12.4 (95% CI 4.6-34.1, p<0.001), but also a greater risk for correctiveosteotomy, OR 12.6 (95% CI 1.4-113.9, p=0.024). Conclusion: Volar comminution and positive ulnar variance are associated with an increasedrisk for re-operation. However, the degree of the risk is difficult to measure due to the lowincidence of re-operations.
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HIRATA, HITOSHI, TAKANOBU NISHIZUKA, KATSUYUKI IWATSUKI, MICHIRO YAMAMOTO, MASAHIRO TATEBE, and SHUICHI KATO. "The Results of Volar Locking Plate Fixation for the Fragility Fracture Population with Distal Radius Fracture in Japanese Women." Nagoya University School of Medicine, 2014. http://hdl.handle.net/2237/19488.
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Ho, Pak-hong Henry. "A new implant for distal radius fracture fixation : from design to testing /." Hong Kong : University of Hong Kong, 2002. http://sunzi.lib.hku.hk/hkuto/record.jsp?B23766025.
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MacDermid, Joy C. "Baseline predictors of pain and disability six-months following distal radius fracture." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1999. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape8/PQDD_0011/NQ42543.pdf.
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何柏康 and Pak-hong Henry Ho. "A new implant for distal radius fracture fixation: from design to testing." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2002. http://hub.hku.hk/bib/B31226061.
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Plant, Caroline Elizabeth. "Outcome and management of acute dorsally displaced fractures of the distal radius." Thesis, University of Warwick, 2016. http://wrap.warwick.ac.uk/89823/.
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Fractures of the distal radius are a common injury, affecting younger patients typically through sporting and road traffic accidents, and older osteoporotic patients often due to falls from a standing height. The potential consequences of these fractures are rare but can be catastrophic, with risk of lasting impairment to the patient. This thesis aimed to examine (1) how surgeons decide which patients with a dorsally displaced distal radius fracture need an operation, (2) what is the evidence basis for the two most commonly performed operations for patients with this fracture in the UK, (3) Are electronic and manual goniometers and dynamometers able to reliably assess wrist function in patients and healthy volunteers, (4) Does the patients’ functional outcome correspond with their radiological outcome, and (5) what is the long-term outcome of these patients. A number of research methods were employed to achieve these objectives. A mixed methods approach was deployed, involving observations of nineteen patient/surgeon consultations followed by mini interviews with the consulting surgeons, to gain an insight into which patients with a dorsally displaced distal radius fracture receive an operation in practice. In-depth interviews were undertaken with 14 Orthopaedic surgeons to explore the patient/surgeon/context related factors that contribute to their decision-making.
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Santos, Ana Rita Matos. "Estudo morfométrico da extremidade distal do rádio do cão." Master's thesis, Universidade de Lisboa. Faculdade de Medicina Veterinária, 2014. http://hdl.handle.net/10400.5/6381.
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Dissertação de Mestrado Integrado em Medicina VeterináriaA extremidade distal do rádio é um local frequente de fratura nos cães e, por isso, o desenvolvimento de implantes ortopédicos específicos que se adaptem melhor às características do osso é imprescindível para que o tratamento cirúrgico tenha maior sucesso. O objectivo desta dissertação foi o de realizar um estudo morfométrico do rádio no cão e avaliar as diferenças que se verificam entre algumas raças e portes, para que, no futuro, o desenho dos implantes seja o mais adaptado possível ao tipo de rádio a intervencionar. Através da avaliação radiológica do rádio de 61 cães com portes diferentes, mediram-se diversos parâmetros morfométricos (comprimento e, ao longo da metade distal do rádio, o diâmetro, o tamanho da cavidade medular e das corticais), que depois foram normalizados pelo tamanho do rádio. Os resultados obtidos através das médias, análise de variância e correlação dos dados sugerem que há diferenças assinaláveis na estrutura morfométrica do rádio, dependendo do comprimento do osso e porte do cão, mas também do grupo racial, isto é, os cães pequenos, médios e grandes não mostram um osso linearmente proporcional, e cães do tipo baixote não apresentam sempre as mesmas tendências que os outros grupos, sendo a sua curvatura distal pronunciada uma das características mais marcantes. Este estudo preliminar contribuiu na definição de diferentes perfis morfológicos e no desenvolvimento de uma base de dados sendo, no entanto, necessário aprofundar os conhecimentos sobre os fatores que influenciam o desenvolvimento e a estrutura morfométrica do rádio.
ABSTRACT - MORPHOMETRIC STUDY OF THE DISTAL EXTREMITY OF THE DOG RADIUS - Fractures of the distal radius are common in dogs, therefore, the development of implants that fit the bone features is fundamental to the treatment success. The purpose of this research work was to perform a morphometric study of the dog radius and to assess the differences between some breeds and dogs sizes, to allow the improvement of implants design in the future. Through radiologic evaluation of 61 dog radius with different sizes, several morphometric parameters were measured (length and the diameter, medullar cavity and corticals through the distal half of the radius). These parameters were then normalized to the length of the respective radius. The results from the mean, analysis of variance and correlations suggests that there are remarkable differences on the morphometric structure of the radius depending on bone length and size of the dog but also on breed group. The bone of miniature, medium and large dogs are not linearly proporcional. That conclusion was observed particularly in short-legged breeds where the bone tented to have a pronounced curvature of the distal radius, one of their most striking features. This study contributes to morphological profile and development of a data base of different breeds; however further studies are needed to better understand the factors that influence the development and morphologic structure of the radius.
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Dean, Maureen A. "Predictions of Distal Radius Compressive Strength by Measurements of Bone Mineral and Stiffness." Ohio University Art and Sciences Honors Theses / OhioLINK, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=ouashonors1461595642.
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Cardone, Lucia. "Investigation of a device for measurement of fracture healing in the distal radius." Thesis, University of Edinburgh, 2006. http://hdl.handle.net/1842/13311.
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The development of a measuring device and technique is presented to measure objectively the healing process in distal radial fractures treated with an external fixator. External fixation is advocated in stabilization of unstable fractures of the distal radius to allow a rapid and better patient recovery. Removal of the external fixator too early can result in risk of refracture or late collapse of the fracture. The measuring device developed here is used to calculate the rigidity of the new callus; this quantitative parameter can contribute to the surgeon’s decision to remove the frame. Bone structure and bone fractures are examined from a mechanical and biological perspective. Fracture treatments and healing patterns are presented with particular attention to external fixators and the environmental fracture conditions imposed by these frames. Previous studies on fracture healing (for tibial and femoral fractures) have been considered during the development of the measuring device. A fracture model has been created and used to verify the reliability of the device in laboratory testing. In-vivo testing has been performed to improve the performance of the device and protocol for using it; specifically, to produce an instrument that can be adapted to suit any external fixator geometry met on patients. A pilot study was subsequently organised and conducted to verify the usefulness and reliability of the device under clinical conditions. In order to compare directly the results from different patients, the influence of various external fixator geometries has been investigated, by a finite element (FE) analysis. The FE analysis has been validated against laboratory testing with the fracture model. Combining measurements from the device and data from the computational model (from the FE analysis), the callus rigidity is determined for patients involved in the pilot study. The trend of the calculated callus rigidity is discussed and the results are compared with the conventional clinical methods to assess fracture healing.
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Kaye, Bryan. "Success Rates for Reduction of Pediatric Distal Radius and Ulna Fractures by ED Physicians." Thesis, The University of Arizona, 2013. http://hdl.handle.net/10150/281753.
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A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine.Objective: To determine the success rates for reduction of pediatric distal radius and/or ulna fractures by emergency department (ED) physicians. Methods: We conducted a retrospective study of children <18 years of age who presented to a large, urban free standing children’s hospital between January 1, 2009 and December 31, 2010 with a fracture of the radius and/or ulna. Patients were excluded if they had an open fracture, were taken directly to the operating room without attempted ED manipulation, or had additional fractures besides isolated radius/ulna fractures. The primary endpoint was the proportion of successful reductions of closed forearm fractures in the ED, as defined by first orthopedic follow up visit. Results: All reductions were performed by Board certified/eligible Pediatric Emergency Medicine (PEM) physician or PEM fellow. There were a total of 15 different PEM faculty and 10 PEM fellows that were involved in the fracture reductions during the study period. There were 295 forearm fractures reduced in the ED during the study period. The mean age was 8.27 years (median 8 years; range 1 to 16) and males comprised 69.2% (n=204) of the study group. A total of 225 (76.3%) fractures were of the distal forearm and 70 involved the midshaft (23.7%). All but 67 (22.7%) patients returned for their orthopedic follow up exam. A total of 33 (14.5%) of all patients required re-manipulation at follow up; 24 in the distal forearm fracture group (22 were closed reductions and 2 open reduction with internal fixation [ORIF]), versus 9 in the midshaft group (7 closed reductions and 2 ORIF). Conclusion: The literature reveals that between 7% and 39% of children who have fracture reductions in the ED by orthopedics will require re-manipulation. Our rate of 14.5% is consistent within that range. With training, pediatric ED physicians have similar success rates as orthopedists in the reduction of forearm fractures.
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Karagiannopoulos, Christos. "RESPONSIVENESS OF THE ACTIVE WRIST JOINT POSITION SENSE TEST FOLLOWING DISTAL RADIUS FRACTURE INTERVENTION." Diss., Temple University Libraries, 2014. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/303494.
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KinesiologyPh.D.
The primary purpose of this study was to determine the responsiveness of the active wrist joint position sense (JPS) test to detect wrist sensori-motor status change at 8 and 12 weeks following distal radius fracture (DRF) treatment intervention. Responsiveness, defined as the instrument's ability to accurately detect change, was analyzed via distribution- and anchor-based statistical methods. Distribution-based analysis encompassed both group- (i.e., effect size [ES], standardized response mean [SRM]) and individual-based (i.e., minimum detectable change [MDC]) statistical indices. Anchor-based analysis was used to determine the minimal clinically important deficit (MCID) value by linking active wrist JPS test scores to Patient Global Impression of Change (PGIC) scale values. The secondary purposes of the study were to: 1) compare the active wrist JPS test responsiveness as reflected by its MCID value between non-surgical and surgical DRF treatment interventions, 2) compare the active wrist JPS test responsiveness as reflected by its MCID value between participants with high- and low-pain levels, 3) compare the active wrist JPS test scores between participants with high- and low-pain levels, 4) assess the relationship between active wrist JPS test MCID value and function, and 5) determine the intra-tester reliability of the PGIC scale for assessing global health status change following DRF treatment intervention. A prospective cohort study design was utilized. Thirty-three participants between 25 and 90 (mean 59.72) years of age following any non-surgical and surgical DRF treatment intervention were recruited. The active wrist JPS test was determined to be highly responsive based on group-based statistical indices (ES [8 weeks = 1.53, and 12 weeks = 2.36] and SRM [8 weeks = 1.57, and 12 weeks = 2.14]). Statistically significant MDC values were 4.28 and 4.94 deg at 8 and 12 weeks following treatment initiation, respectively. Clinically meaningful MCID values at 8 and 12 weeks were 5.00 and 7.09 deg, respectively. Responsiveness levels were not significantly different between the two treatment and pain-level groups at 8 and 12 weeks post DRF treatment intervention. High-pain participants demonstrated significantly greater JPS deficits at both 8 and 12 weeks, and a significant association existed between active wrist JPS test MCID value and function. The PGIC scale intra-tester reliability was found to be high (ICC = 0.97). Based on this study's findings, clinicians can use this highly responsive test with confidence to measure statistically and clinically meaningful conscious wrist sensori-motor function change following DRF treatment.
Temple University--Theses
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Reddie, Lianne Catherine Rose. "A study of growth and development in the distal radius using the metaphyseal index." Thesis, University of Manchester, 2011. https://www.research.manchester.ac.uk/portal/en/theses/a-study-of-growth-and-development-in-the-distal-radius-using-the-metaphyseal-index(012d3c1d-8e2a-44ac-9b4f-dd3084e33714).html.
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Introduction: Metaphyseal inwaisting is a process that occurs during long bone growth and remodelling of epiphyses and results in a proportional increase in growth plate width (GPW) and a decrease in metaphyseal width (MW). The Metaphyseal Index (MI) compares GPW to MW, usually in the distal femur. However, due to bone-age assessments, the most commonly performed radiograph in children is that of the hand/forearm. Previous work showed that gymnasts have a more widened growth plate at the distal radius than normal children, but these studies did not quantify the morphological changes using the MI and pQCT measures. Previous studies have shown that the use of DXA hand/forearm images for the purposes of bone-age assessment were unreliable for children aged 11 and under. Aims: Examine distal radius morphology of 378 Normal subjects (155 male), 36 Gymnast subjects (15 male), 17 NF1 subjects (7 male) and 108 CDGP subjects (83male) to calculate the precision of MI, MW and GPW measurements, to determine a normal reference range for the MI in Normal subjects and use this to compare to the other 3 groups, and to compare longitudinal measurements. Also, to investigate whether DXA software upgrades have improved the ability to make TW3 bone-age assessments, to investigate how closely DXA compares with standard radiographs using 98 (38 male) DXA hand images and radiographs, and calculate the precision (CV%) of the GP and TW3 bone-age assessment methods. Methods: Anthropometric data, Tanner stage, posterior-anterior hand radiographs and pQCT scans of the non-dominant hand/forearm were obtained. MI was measured using a semi-automated computer-assisted method. Statistical analyses were used to compare males and females, and compare the Normal group to other groups. Also, DXA images and radiographs were assessed by the same assessor and the TW3 and GP bone-ageing methods were compared. A CV% was calculated for both comparisons. Results: The CV% of MI, MW and GPW = 1.05%, 0.92% and 1.28% respectively. MI of males and females was not statistically different in any group. The MI of Gymnasts was significantly lower than the Normal group (p = 0.008). The NF1 and CDGP groups were not significantly different from the Normal group. Longitudinal measurements indicated those with a low/high MI at the first visit were likely to have a low/high MI at the second visit, though occasionally the MI would decrease between visits. DXA bone age assessments proved to be reliable in subjects of all ages assessed in this study and showed a CV% only slightly higher than standard radiographs (CV = 2.95% DXA vs2.68% radiograph). The CV% of GP and TW3 methods = 2.68% & 1.61% respectively. Discussion: The CV% of MI, MW and GPW shows these methods to be very precise. The mean MI of gymnasts is significantly lower than in normal children due to a widening of the growth plate and not due to a reduction in metaphyseal width. Insufficient subject numbers and smaller age ranges, particularly in the Gymnast and NF1 groups may play a part in the non-significant differences between them and the Normal group. DXA CV% shows that DXA is almost interchangeable with standard radiographs. The TW3 and GP CVs% show that TW3 bone-age assessment is more precise than the GP method. This confirms the tight control that the MW and GPW have in proportion to each other. This is the first study to quantify changes in distal radius morphology in normal, athlete and disease groups, and create a range of normal reference values, which could be useful for future work in this area.
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Christersson, Albert. "Fractures of the distal radius : Factors related to radiographic evaluation, conservative treatment and fracture healing." Doctoral thesis, Uppsala universitet, Ortopedi, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-312931.
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Distal radius fractures (DRFs) are one of the most common injuries encountered in orthopaedic practise. Such fractures are most often treated conservatively, but surgical treatment has become increasingly common. This trend is not entirely scientifically based The aims of this thesis were threefold: to increase measurement precision in dorsal angulation (DA) on radiographs and computer tomographies (CTs); to assess the results after shortened plaster cast fixation time in reduced DRFs; and to evaluate the feasibility and safety of applying Augment® (rhPDGF-BB/β-TCP) in DRFs. In Paper I and Appendix 1 and 2, a semi-automatic CT-based three-dimensional method was developed to measure change in DA over time in DRFs. This approach proved to be a better (more sensitive) method than radiography in determining changes in DA in fractures of the distal radius. In Paper II, a CT model was used to simulate lateral radiographic views of different radial directions in relation to the X-ray. Using an alternative reference point on the distal radius, precision and accuracy in measuring DA was increased. Paper III and IV are based on a prospective and randomised clinical study (the GitRa trial) that compares clinical and radiographic outcomes after plaster cast removal at 10 days versus 1 month in 109 reduced DRFs. Three patients in the early mobilised group were excluded because of fracture dislocation (n=2) or a feeling of fracture instability (n=1). For the remaining patients in the early mobilised group (51/54) a limited but temporary gain in range of motion, but a slight increase in radiographic displacement were observed. Our results suggest that plaster cast removal at 10 days after reduction of DRFs is not feasible. Paper V is based on a prospective, randomised clinical study (the GEM trial) in which 40 externally fixated DRFs were randomised to rhPDGF-BB/β-TCP into the fracture gap or to the control group. Augment® proved to be convenient and safe during follow-up (24 weeks). However, because of the nature of the study design, the effect on fracture healing could not be determined. A decrease in pin infections was seen in the Augment® group, a finding we could not explain.
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Zapata, Edison. "Bone strength of the human distal radius under fall loading conditions : an experimental and numerical study." Thesis, Lyon 1, 2015. http://www.theses.fr/2015LYO10275/document.
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Les fractures de fragilité représentent un problème de santé publique pour les personnes âgées. L'évaluation de la résistance osseuse et du risque de fracture par la méthode de référence (absorption bi-photonique à rayons X, DXA) est limitée. Les micro-modèles en éléments finis (µFEM) ont montré de meilleures prédictions de la résistance osseuse, mais on ne peut confirmer qu’ils améliorent l’estimation du risque de fracture par rapport à la DXA. L'objectif de cette thèse était donc d'évaluer si la prédiction par simulation numérique pouvait être améliorée en prenant en compte des conditions réalistes de chargement. Tout d’abord, les conditions de chargement correspondant à une chute vers l’avant ont été reproduites sur 32 radius humain dans une expérimentation ex-vivo. Les résultats expérimentaux ont conduits à deux groupes : un fracturé et un non fracturé. Puis, la capacité de prédiction d’un modèle « ségment » (9 mm de radius distal) créé en utilisant un scanner à très haute résolution (High Resolution peripheral Quantitative Computed Tomography) a été évaluée. . Différentes configurations (axiale (configuration standard) et 5 non-axiales) ont été simulées. L’implémentation de chargement non-axial n’a pas amélioré la capacité de prédiction du modèle « segment ». Finalement, un modèle hétérogène du radius distal entier a été créé à partir d’un scanner clinique (Cone Beam Computed Tomography). Ce modèle a pris en compte les conditions d’une chute en termes d’orientation et de vitesse. Le modèle de radius distal entier a montré une meilleure prédiction de la charge à la rupture expérimentale que le modèle « segment ». Cette étude propose des données originales pour la validation de modèles numériques pour l’amélioration de la prédiction du risque de fractureFragility fractures represent a public health problem for elderly. The assessment of the bone strength and of the risk of fracture by the gold standard method (Dual X-ray Absorptiometry - DXA) is limited. Micro-finite element models (µFEM) have shown to better predict the bone strength, but it is not possible to confirm that they do better than the density measured by DXA to estimate the risk of fracture. Thus, the aim of this thesis was to evaluate whether including realistic loading conditions could improve the level of prediction of the FEM. First, we reproduced the loading conditions of a forward fall on 32 radii in an ex-vivo experiment. This experiment leaded to two groups: one fractured and one non - fractured. Then, we evaluated the prediction capability of a segment FEM (9 mm of the distal radius) created using the High Resolution peripheral Quantitative Computed Tomography. This segment FEM was tested under the axial loading (standard analysis), and under five additional non-axial configurations. It was found that the prediction capability of the segment FEM was not improved by the implementation of non-axial loadings. Finally, a heterogeneous FEM of the whole distal radius was created using data from a Cone Beam Computed Tomography. This model considers the fall loading configurations in orientation and speed of the ex-vivo experiment. The FEM of the whole distal radius has a better accuracy to predict the experimental failure load than the segment FEM. This study proposes original data for model validation dedicated to further improvements of fracture risk prediction
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Wong, Tak-chuen. "Casting versus percutaneous pinning for extra-articular fracture distal radius in a Chinese elderly population : a prospective randomized controlled trial /." View the Table of Contents & Abstract, 2007. http://sunzi.lib.hku.hk/hkuto/record/B38348251.
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Wadsten, Mats. "Distal Radius Fractures : aspects on radiological and clinical outcome and evaluation of a new classification system." Doctoral thesis, Umeå universitet, Institutionen för kirurgisk och perioperativ vetenskap, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-118544.
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Distal radius fracture (DRF) is the most common fracture encountered in clinical practice. Every year, more than 20000 people in Sweden suffer from this injury. It has been shown that there is a correlation between malalignment and function following distal radial fractures and malunion may cause persistent pain and disability. A problem has been in making a correct initial assessment of the fracture. Many fractures are unstable despite an acceptable position on the initial radiographic examination or following a successful closed fracture reduction. Numerous classification systems have been developed for evaluation of DRF in order to predict the outcome. However, the values of these are limited since they have not shown satisfactory reliability. Furthermore, the utility of these systems to predict radiographic or clinical outcome is not yet proven. These shortcomings may be one reason why optimal DRF management is still controversial. Requests for a new classification system of DRF, predictive of outcome and easy to use, have been made. Improvement in initial assessment of DRF will benefit a large group of patients, as well as the society, by reducing persistent symptoms and disability. Study I: In this study we evaluated the interobserver and intraobserver reliability of a new classification system (the Buttazzoni classification). Two hundred and thirty-two patients with acute DRF were blindly evaluated using the new classification by three orthopaedic surgeons twice with a 1-year interval. The new classification showed fair to substantial interobserver and intraobserver reliability, i.e., results comparable with other commonly used classification systems. Study II: This was a prospective multicenter study of fracture stability in 428 DRF. The study investigated whether cortical comminution and intra-articular involvement, as well as the new classification system, could predict displacement in DRF. Logistic regression analysis showed that initial position of the fracture and volar or dorsal comminution predicted later displacement, while intra-articular involvement did not. Volar comminution was the strongest predictor of displacement. The new classification system, which is the first to include volar comminution as a separate parameter, was highly predictive of fracture instability. Furthermore we found that it is quite common for non-operatively treated fractures to displace at a later stage than two weeks. Study IV: In study II it was found that late displacement of DRF, still in acceptable radiologic position after 10-14 days, occurred in approximately 1/3 of cases. Despite this, we have not been able to find any study focusing on evaluating the clinical outcome in patients with late displacement. Two hundred and nine unilateral DRF from study II were still in good position after 10-14 days and were included in the study. One hundred and seventy five patients had radiographs taken at a minimum of 3 months and a clinical examination 1 year after the fracture. Late displaced distal radius fractures had significantly higher loss of ROM and grip strength compared to fractures that didn’t displace. No significant differences were seen in subjective outcome. In conclusion, initial position of the fracture predicted later displacement and was the most important parameter in predicting clinical outcome. Comminution of the fracture also affected radiological stability and clinical outcome. Volar comminuted fractures are highly unstable and need surgical intervention if displacement is to be avoided. Intra-articular involvement affected clinical outcome. Late displacement is common in DRF and may result in loss of range of motion and grip strength. To detect late displacement, DRF should be followed for more than 2 weeks. The new classification system had a moderate reliability and reproducibility. The classification was found predictive of radiologic and objective clinical outcome. However, it was not predictive of subjective outcome. The classification system was also predictive of fractures at risk for late displacement.
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Ito, Gisele Gonsalez. "Sistema mecatrônico para reabilitação pós fratura da extremidade distal do rádio." Universidade de São Paulo, 2011. http://www.teses.usp.br/teses/disponiveis/18/18149/tde-23032011-101648/.
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A fratura da extremidade distal do rádio é o tipo de lesão mais comum encontrada nos departamentos de emergência ortopédica. Requer reabilitação efetiva que pode ser feita com contribuições de tecnologias atuais. Para isto foi construído um sistema mecatrônico móvel e interativo a partir de conhecimentos de especialistas na área da saúde e engenharia. O sistema foi testado em trinta pessoas saudáveis, sendo eles profissionais das áreas citadas e a população mais acometida: homens jovens e mulheres pós-menopausa. Os dados obtidos foram analisados, assim como as pistas sociais apresentadas pelos participantes. Após os testes todos responderam um questionário para avaliar o sistema. Os resultados mostraram que o sistema cumpre grande parte dos requisitos necessários para a reabilitação, mas precisa de melhorias.Distal radius fracture is the most common type of injury found in emergency of orthopedic department. It requires effective rehabilitation that can be made with contributions of current technologies. For this, a mobile and interactive mechatronic system was built from the expertise of specialists in healthcare and engineering. The system was tested in thirty healthy people, the professionals of these areas and the population most affected: young men and postmenopausal women. The data and the social cues presented by the participants were analyzed. They answered a questionnaire to evaluate the system. The results showed that the system meets many rehabilitation requirements, but improvements are necessary.
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Sano, Takahiro. "Biomechanics of Fixation of Distal Radius Fractures: Comparison between Volar Plate Fixator (VPF) and Non-Bridging External Fixator (NBX)." Scholarly Repository, 2008. http://scholarlyrepository.miami.edu/oa_theses/121.
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Fracture of the distal radius is one of the most frequent injuries, and it represents about 20% of all adults taken into emergency rooms. A number of studies suggest various methods to reduce the dislocation and to secure fragments of the distal radius. In this study, the Non-Bridging External Wrist Fixator System (NBX), a pre-market-released product manufactured by NUTEK Inc. was biomechanically assessed by comparing with the Universal Distal Radius System (Volar Plate Fixator: VPF), a market-released product manufactured by Stryker Co. The comparison was performed in several parameters, which were wrist motion, radial tilt angle, radial length, volar tilt angle, stiffness, and failure load. Five pairs of fresh human cadaver arms were used for this study. The wrists were tested to obtain x-ray images for 1 normal and 2 injury conditions (intact, fractured, and fixed), 2 load conditions (gravity only and torque applied), and 4 postural conditions (volar flexion, dorsiflexion, ulnar deviation, and radial deviation). These tests yielded 24 (3×2×4) x-ray images for each wrist, and the images were analyzed to obtain the data for each parameter. Although the results were not statistically significant in some conditions, NBX fixation limited wrist motion more than VPF fixation. This result can be explained not only by the difference in the ability of fixation, but also by the difference in the surgical trauma (NBX is less invasive than VPF). Furthermore, in the measurement of radial tilt angle, radial length, and volar tilt angle, NBX was more effective than VPF to reduce and secure the bone fragments of the distal radius. In destructive test, the NBX is less strong than VPF. However, NBX is strong enough to sustain the expected forces of daily activity.
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Karantana, Alexia. "Fractures of the distal radius : does operative treatment with a volar locking plate improve outcome? : a randomised controlled trial." Thesis, University of Nottingham, 2014. http://eprints.nottingham.ac.uk/27886/.
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Background and aims The advent of volar locking plates designed specifically for fractures of the distal radius has resulted in a major shift away from percutaneous fixation of these injuries. However, comparative studies have not always demonstrated better outcomes than those achieved with less invasive and potentially less expensive established techniques. The present study was a randomized controlled trial comparing the outcome of displaced distal radius fractures when treated with a volar locking plate or closed reduction and percutaneous wire fixation, with supplemental bridging external fixation when required. The primary research objective was to ascertain whether the use of volar locking plates improves functional outcome in the short and medium term. The secondary objective was to determine, through economic evaluation, whether the use of volar locking plates for distal radius fractures is of financial benefit to the health service. Methods A single-centre randomized controlled trial of pragmatic design, conducted in a tertiary care institution, with accompanying economic evaluation. 130 patients with displaced distal radius fractures were randomised to either volar locking plate (n=66) or conventional percutaneous fixation methods (n=64). Outcome assessments were conducted at 6 weeks, 12 weeks and 1 year. The primary outcome measure was the PEM score at one year. Secondary outcomes included the QuickDASH, PRWE, EQ-5D and SF-12 scores, range of motion, grip strength, radiographic and cost parameters. A cost-effectiveness analysis was performed from the perspective of the NHS, and in line with NICE guidance on the methods of technology appraisal. “Bottom up” micro-costing methods were used to calculate costs for each treatment pathway, prospectively collecting information on consumables, inpatient and outpatient resource use, complications and additional procedures up to a year post surgery. Main findings Patients in the volar locking plate group had significantly better PEM, QuickDASH, PRWE scores and range of motion at 6 weeks, with no differences at 12 weeks and 1 year. Grip strength was better for the plate group at all time points. The volar locking plate was better at restoring the radiographic parameters of palmar tilt and radial height. Despite the early functional advantage, patients did not return to work sooner. Quality of life scores were marginally, but not significantly, better for the plate group at early follow-up. Both groups returned to baseline at one year. NHS costs for the plate group were significantly higher. For an additional £713, VLP fixation offered 0.018 additional QALYs in the year post surgery. The incremental cost effectiveness ratio (ICER) for VLP fixation at NHS list price was £40,068. Conclusion The current study showed that use of a volar locking plate resulted in better early post-operative function. However, there was no significant difference at, or after 12 weeks. The volar locking plate achieved better radiographic reduction and measured grip strength, but this did not translate to a difference in function at 12 weeks and 1 year. The earlier recovery of function may be of advantage to some patients. However, in spite of their increasing use and popularity, volar locking plates were cost-ineffective according to NICE threshold criteria.
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Araf, Marcelo. "Estudo das lesões ligamentares e condrais nas fraturas articulares da extremidade distal do rádio: avaliação artroscópica." Universidade de São Paulo, 2008. http://www.teses.usp.br/teses/disponiveis/5/5140/tde-02062008-112029/.
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As fraturas da extremidade distal do rádio são muito comuns em nosso meio, sendo a mais freqüente do punho. Inúmeras pesquisas já foram realizadas sobre o tema e é conhecida a importância da redução anatômica das fraturas intra-articulares; porém, a causa de insucesso no seu tratamento pode ser a associação de outras lesões, envolvendo partes moles e cartilagem. O objetivo foi realizar uma avaliação artroscópica para analisar a incidência das lesões ligamentares e condrais associadas às fraturas intraarticulares da extremidade distal do rádio, correlacionado-a com classificação AO/ASIF. Trinta pacientes, com idade entre 20 a 50 anos, portadores de fratura fechada dos grupos B e C da classificação AO/ASIF foram selecionados. Todos eles foram submetidos à artroscopia do punho, para abordar as lesões intra-articulares e para redução e osteossíntese da fratura. Observou-se uma alta incidência de lesões intra-articulares, sendo que 76,7% deles apresentavam lesão do complexo da fibrocartilagem triangular, 36,6% do ligamento intrínseco escafo-semilunar, 6,6% do ligamento intrínseco semilunar-piramidal e 33,3% com lesão da cartilagem articular maior que três milímetros. Pacientes portadores de fraturas tipo C da classificação AO/ASIF apresentam uma incidência maior de lesões ligamentares associadas. Não houve relação entre a presença de lesão cartilaginosa e a classificação AO/ASIF das fraturas nesta casuística.Fractures of the distal end of the radius are very frequent in our country and the most common is that of the wrist. Much research was carried out on the subject and the importance of the anatomical reduction of intra-articular fractures is well known, however the cause of unsuccessful treatment may be the association of other injuries involving soft tissues and cartilage. The purpose here was to perform an arthroscopic evaluation to analyze the incidence of ligament and chondral injuries associated to intra-articular fractures of the distal end of the radius, for correlation with the AO/ASIF classification. Thirty patients ranging from 20 to 50 years of age, bearers of closed fractures of groups B and C of the AO/ASIF classification were selected. They were submitted to wrist arthroscopy to treat the intra-articular injuries for fracture reduction and osteosynthesis. A high incidence of intraarticular injuries was noted, 76.7% of them presenting injury of the triangular fibrocartilage complex, 36.6% of the intrinsic scapholunate ligament, 6.6% of the intrinsic lunotriquetral ligament and 33.3% of an injury of the articular cartilage larger than three millimeters. Patients bearers of a type C fracture in the AO/ASIF classification present with a higher incidence of associated ligament injuries. No relation between presence of cartilage injury and AO/ASIF Classification was found in this casuistry.
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Wong, Tak-chuen, and 王德銓. "Casting versus percutaneous pinning for extra-articular fracture distal radius in a Chinese elderly population: a prospective randomized controlled trial." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2007. http://hub.hku.hk/bib/B45011539.
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Rösch, Kerstin [Verfasser]. "Retrospektive Analyse diaphysärer und distal metaphysärer Radius/Ulna-Frakturen beim Hund nach Plattenosteosynthese und Osteosynthese mit Fixateur externe / Kerstin Rösch." Berlin : Freie Universität Berlin, 2021. http://d-nb.info/1233986821/34.
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Ribak, Samuel. "Tratamento da pseudoartrose do escafoide = estudo comparativo entre o uso do exerto ósseo da extremidade distal do rádio vascularizado e não vascularizado." [s.n.], 2010. http://repositorio.unicamp.br/jspui/handle/REPOSIP/311306.
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Orientador: Maurício EtchebehereTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
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Resumo: Avaliaram-se os aspectos clínicos, funcionais e radiográficos de 86 pacientes portadores de pseudoartroses do escafoide. Comparam-se 46 pacientes submetidos à técnica de enxerto ósseo vascularizado dorsal do rádio distal, baseado na artéria suprarretinacular intercompartimental 1,2* (Grupo I), e 40 pacientes submetidos à cirurgia pela técnica de enxerto ósseo convencional não vascularizado da mesma região, rádio distal (Grupo II), objetivando definir o melhor procedimento quanto à consolidação e função. A amostra foi composta por 25 pseudoartroses no terço médio e 21 no polo proximal nos pacientes do Grupo I, e 22 no terço médio, duas no polo distal e 16 no polo proximal nos pacientes do Grupo II. No transoperatório, 30 escafoides foram considerados não vascularizados nos pacientes do Grupo I, e 20 nos pacientes do Grupo II. A estabilização do escafóide foi realizada por três fios de Kirschner e, no pós-operatório, todos os pacientes foram submetidos à imobilização com tala gessada antebraquiopalmar por quatro semanas. O tempo de seguimento médio pósoperatório foi de 24.4 meses (Grupo I), e de 21.7 meses (Grupo II). Conseguiu-se consolidação de 89.1% nos pacientes do Grupo I e tempo médio de consolidação de 9.7 semanas. Nos pacientes do Grupo II, houve consolidação em 72.5%, com tempo médio de 12 semanas. Os resultados funcionais do Grupo I foram satisfatórios em 72% dos pacientes e 57,5% no Grupo II. Concluímos que a técnica de enxerto ósseo vascularizado apresenta, quanto ao índice de consolidação e função, resultados superioresaos do procedimento não vascularizado, sendo mais eficiente quando a condição do polo proximal do escafoide é esclerótica
Abstract: The clinical, functional and radiographic aspects of 86 patients presenting with scaphoid nonunion were evaluated in this study. Forty-six patients undergoing the technique of vascularized bone graft from the dorsal distal radius, based on the 1, 2 intercompartmental supraretinacular artery (Group I), and 40 patients undergoing the technique of usual nonvascularized bone graft of the same area (distal radius) (Group II), are compared with the purpose of determining the best procedure concerning healing and function. Our sample comprised nonunions in 25 middle-third and 21 proximal-pole patients (Group I), and in 22 middlethird, 2 distal-pole, and 16 proximal-pole patients (Group II). Transoperatively, 30 scaphoids in Group I patients and 20 in Group II patients were considered sclerotic. Scaphoid stabilization was achieved with three K-wires and, postoperatively, and immobilization consisted of a short-arm cast for all patients for four weeks. The average postoperative follow-up time was 24.4 months for Group I, and 21.7 months for Group II. Healing was achieved in 89.1% of Group I patients, with an average healing time of 9.7 weeks. Within Group II, healing was achieved in 72.5% of patients, with an average healing time of 12 weeks. The functional results were satisfactory in 72% of Group I patients and 57.5% of Group II patients. We therefore conclude, from the healing and function indices, that the vascularized bone graft technique produces superior results than the nonvascularized bone graft procedure, being more efficient when the proximal pole of the scaphoid is sclerotic
Doutorado
Fisiopatologia Cirúrgica
Doutor em Ciências
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Cewers, Ingrid, and Viveka Palmqvist. "Patientens upplevelse av smärtbehandling efter operation av distal radiusfraktur med perifer nervblockad." Thesis, Röda Korsets Högskola, 2010. http://urn.kb.se/resolve?urn=urn:nbn:se:rkh:diva-101.
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Syftet med studien var att utvärdera patientens upplevelse av den postoperativa smärtan och behandlingen av denna när den perifera nervblockadens effekt avtagit efter operation av distal radiusfraktur. Metoden som använts är en empirisk kvantitativ deskriptiv enkätstudie. Tjugo patienter deltog i denna pilotstudie. Demografin stämde väl överens med de statistiska data, som visar att distrala radiusfrakturer är vanligt förekommande hos kvinnor i åldern 55 år och äldre. Resultatet av studien har påvisat att många patienter har upplevt mer smärta än vad de själva varit beredda på. Slutsatsen utifrån visuell analog skala, VAS, visar att smärtan har varit svår för patienterna att behandla hemma trots att de haft tillgång till smärtbehandlade läkemedel. Informationen som patienten erhållit har varit otillräcklig och kan vara en källa till den svårbemästrade smärtan.The aim of the study was to evaluate patient´s experience of the postoperative pain and its treatment after peripheral nerve blockade for operation of a distal radius fracture had ceased. The method used was an empiric, quantitative, descriptive study using enquiries. Twenty patients participated in this pilot study. Demography was according to statistical data, that distal radius fractures are common in women aged 55 or more. The results showed that many patients experienced more severe pain than expected. The conclusion from visual analogue scale, VAS, shows that the pain was difficult to treat at home in spite of prescription of pain killers. The information given to the patient was insufficient, which may have contributed to the difficulty to control pain.
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Björkman, Maria, and Susanna Ingemarsson. "Kvinnors smärtupplevelse efter dagkirurgisk operation av distal radiusfraktur : En jämförelse mellan plexusblockad och infiltrationsanestesi." Thesis, Högskolan i Borås, Akademin för vård, arbetsliv och välfärd, 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:hb:diva-26271.
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Bakgrund: Distal radiusfraktur är den vanligaste frakturen i Sverige där kvinnor drab-bas oftare än män. Majoriteten av de patienter som opereras vårdas på en dagkirurgisk enhet och sköter sin egenvård i hemmet. Kvinnor upplever smärta annorlunda än män vilket kan ha betydelse i valet av smärtlindringsstrategi. Inför operationen erhåller patienten antingen en plexusblockad eller generell anestesi med infiltrationsanestesi i smärtlindrande syfte. I anestesisjuksköterskans kompetensbeskrivning ingår det att ansvara för planering och övervakning vid dessa olika anestesimetoder. Vilken av de två anestesimetoder som används varierar på sjukhusen runt om i Sverige. Det finns ett begränsat forskningsunderlag på vilken anestesimetod som är att föredra. Syfte: Syftet var att undersöka smärtupplevelsen hos kvinnor efter dagkirurgisk operation av distal radiusfraktur. En jämförelse mellan anestesimetoderna plexusblockad och infiltrationsanestesi med Ropivacain. Metod: En kvantitativ enkätundersökning. Data har samlats in genom ett bekvämlighetsurval där enkäten bestående av strukturerade frågor har delats ut av personal på sju postoperativa avdelningar. Resultat: Inga statistiskt signifikanta skillnader har hittats mellan grupperna som erhållit antingen plexusblockad eller infiltrationsanestesi med Ropivacain. Dock visade sig en betydande andel uppleva svår eller värsta tänkbara smärta kvällen eller natten efter operation. Båda grupperna uppvisar även problem med sömn och vila postoperativt. Slutsatser: Resultatet från magisteruppsatsen antyder att det finns förbättringspotential postoperativt för kvinnor med radiusfraktur som upplever smärta. Dessutom bör grundläggande behov, särskilt vila, sömn och aptit, tas i beaktande.Background: Distal radius fracture is the most common fracture in Sweden and women are affected more often than men. The majority of the patients who require surgery are cared for in a day surgery unit. They are then responsible for their own care at home. Women experience pain differently than men and this can be important when deciding upon a pain relief strategy. Prior to surgery, the patient receives either a plexus blockade or general anesthesia with infiltration anesthesia for pain relief purposes. The nurse anesthetist´s (CRNA) competence description includes being responsible for planning and monitoring of these different anesthesia methods. The choice of anesthesia method used varies in hospitals around Sweden. There is a limited amount of research on which anesthesia method is preferable. Method: A quantitative survey. Data has been collected using convenience sampling where a questionnaire consisting of structured questions was distributed by hospital staff in seven postoperative departments. Results: No statistically significant differences were found between the groups that received either plexus block or ropivacaine infiltration anesthesia. However, a significant proportion were found to experience either severe pain or the worst possible pain in the evening or night after surgery. Both groups show problems with sleep and rest postoperatively, while the infiltration group tends to be more inconvenienced by decreased appetite than the patients in the plexus group. Conclusions: The results of the master's thesis suggest that there is potential for improvement for postoperative female patients with a radius fracture experiencing pain. Additionally basic needs, in particular rest, sleep and appetite, should be taken into account.
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Charters, Alan. "Detection of distal ulna and radius fractures using thermal imaging as a diagnostic tool on children in the Emergency Department setting." Thesis, University of Portsmouth, 2014. https://researchportal.port.ac.uk/portal/en/theses/detection-of-distal-ulna-and-radius-fractures-using-thermal-imaging-as-a-diagnostic-tool-on-children-in-the-emergency-department-setting(de53a4a9-d7dc-4acd-bb22-3967bf688127).html.
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Aims of the study: The aim of this pilot study was to examine whether a full phase III study would be beneficial in determining whether thermal imaging can be used as a diagnostic tool to detect distal ulna and radius fractures in children who attend the emergency department with an injury to their wrist when compared with the gold standard of X-rays. Methods: Following ethical approval and informed consent, patients meeting the inclusion criteria with injuries to their distal forearms were recruited in to this investigation. The pilot study design was a quasi-experimental controlled trial of 67 patients evaluating whether thermal imaging could detect fractures in children’s distal ulna and radius. All patients enrolled into this trial were treated in accordance with the European Thermography Association standard for carrying out diagnostic studies using infra imaging (Clark & DeCalci-Goff, 1997). All of the children enrolled into this study had thermal images taken of their injured arm (case) and their uninjured arm (control). The thermal imaging took place alongside the X-ray, ensuring that the same person conducted the positioning of the child’s wrist, thus ensuring consistency in image capture. The child was then treated appropriately in accordance to the X-ray results. The data from the thermal imaging was not analysed for six-months post the child’s attendance at the ED in order to reduce the chances of interpreter bias. Results: The results from this study found that there was a statistically significant difference in surface temperature of the injured arm when compared to the control (mean difference 0.90°C, 95% CI: 0.72 to 1.07, p < 0.0001). The magnitude of the difference is significant enough to suggest that a pathological change had taken place. Thirty one out of thirty four children diagnosed with fractures on X-ray showed a surface temperature difference of 1°C or greater when compared with the control (mean difference = 1.28, 95%CI .889 to 1.689). When the fracture group was compared with the injured non-fractured group, a mean difference of 1.084 °C (95% CI = 0.62 to 1.54,p<0.0001) was found. When compared with radiographs, thermal imaging returned a sensitivity of 91.18 % with a specificity of 87.85%; the sensitivity is increased to 96.7 % when the clinical examination is taken into account. In this study the likelihood ratio for the positive test was calculated to be 7.52 %. The negative likelihood ratio was calculated to be 0.1 %. Conclusion: This study has shown that thermal imaging may be useful in detecting fractures of the distal ulna and radius in children’s wrists, however its diagnostic accuracy is questionable, returning a sensitivity of only 91.8% when compared with X-rays (96.8%) however,when used alongside clinical examination the results demonstrate a sensitivity of up to 96.7%. This study has demonstrated that thermal imaging can detect quantifiable differences in temperature, between an uninjured wrist, a soft tissue injury and a fracture. However its accuracy in diagnosing a fracture cannot be guaranteed and does not reach the accuracy of X-rays, which are consdered to be the current diagnostic gold standard. A full phase III multi centered study would be useful in determining whether thermal imaging could be a useful adjunct to the diagnosis of fractures within the wider health care setting, to elucidate whether thermal imaging has a role in reducing the amount of unnecessary X-rays carried out on children with suspected fractures to their wrists.
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Holt, Nicole, Ronald C. Hamdy, Shimin Zheng, W. Andrew Clark, Arsham Alamian, Casey Morrell, Tommy B. Piggee, and Christian Magallanes. "Efficacy of Osteoporosis Diagnosis Using DXA Scans of the Distal Radius in a Group of Male Patients with Osteoporosis: a Retrospective Study." Digital Commons @ East Tennessee State University, 2016. https://dc.etsu.edu/etsu-works/106.
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Osteoporosis is a disease characterized by low bone mineral density (BMD), which compromises bone tissue increasing fragility and susceptibility to fracture. It affects nearly 50% of women and 20% of men over the age of 50, and fractures resulting from osteoporosis cause significant morbidity and mortality. Therefore, patients with or at risk for osteoporosis should be identified before rather than after a fracture occurs. The gold standard in diagnosing patients with osteoporosis is dual X-ray absorptiomerty (DXA). The purpose of this study is to evaluate the usefulness of assessing BMD at various parts of the distal radius (ultra-distal, mid-point, one third, and total) compared to the conventional sites (lumbar vertebrae and proximal femur) using DXA to diagnose osteoporosis. This was a retrospective study on 1,641 male patients over the age of 50 who had undergone bone densitometry (DXA scans) of at least one hip, lumbar vertebrae and distal radius. Ordinary regression and correlation analysis was used to assess the association between the lowest of the bone density scores of the hip or lumbar vertebrae and scans at the various sites on the radius. Comparing standardized scores from the radius method with the lowest standardized scores from the hip or lumbar vertebrae, a highly significant correlation was found, R = 0.59, p < 0.001 for the left UD radius, R =0.59, p < 0.001 for left MD radius, R =0.54, p < 0.001 for the left 1/3 radius, and R =0.60, p < 0.001 for the total left radius. The results indicate that the left radius total is the most accurate in diagnosing osteoporosis in our study population. The results of this study can have far-reaching psychosocio-economic implications showing that DXA scans of the distal radius can be used to effectively diagnose osteoporosis by using inexpensive, low-technology, portable scanners. These findings are particularly relevant to the needs of the undeserved rural populations of Central Appalachia.
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Nordvall, Helena. "Factors in secondary prevention subsequent to distal radius fracture : Focus on physical function, co-morbidity, bone mineral density and health-related quality of life." Doctoral thesis, Umeå universitet, Sjukgymnastik, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-22102.
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In Sweden approximately 25000 distal radius fractures occur annually, which is 37 % of all fractures related to osteoporosis. In this thesis, risk factors for osteoporosis, bone mineral density (BMD) and health-related quality of life (the SF-36) were compared in patients who suffered a distal radius fracture after low energy trauma with a control group matched on the basis of age, gender, and municipality of residence. The aim was also to analyse, among these patients, whether a risk factor questionnaire, tests on dynamic and static balance and a one-leg rise test could identify those, who have osteopenia or osteoporosis, and run a risk of new falls. Moreover, in a three-year follow-up, mortality, the need for in- and outpatient care, and health-related quality of life after radius fracture were investigated and compared between the patients and matched controls. Finally, the effect of a preventive intervention program including patient education and self-training was evaluated. Falls were reported in a risk factor questionnaire and in a fall diary. The patients aged 45-64 years showed lower, although not statistically significant, BMD, compared with the controls of the same age, but there was no difference concerning their history of falls. In contrast, the patients aged 64 years or older had a history of falling more often than the corresponding controls, but no difference in BMD was found. For all other risk factors, except falls, no differences were found between the patients and the controls. The results of the one-leg rise test were associated with those of dynamic and static balance, but none of the functional tests were associated with the number of falls. Decreased height and cigarette smoking were the only risk factors, which predicted osteopenia and osteoporosis. Five patients, although none of the controls, died during the study time. The patients needed statistically significantly more episodes as inpatients than the controls. The patients also had lower SF-36, Role Physical scores, than the controls at three months. This difference disappeared by the time of the follow-up. Both the patients, who participated in a four-week intervention program, “the osteoporosis school” followed by a one-year home-based exercise program, and the controls showed statistically significantly improved dynamic and static balance, ability to walk backwards and to stand on one leg with eyes open and closed at the end of the study. However, no significant differences were found between the patients and the controls in any of the tests, in BMD or in the number of the falls. The thesis shows that, except for the falls in patients aged over 64 years, there were no significant differences between patients and controls with respect to BMD and other risk factors related to osteoporosis. Consequently, in patients aged 45-64 years and older, the underlying cause of a distal radius fracture is more related to falls than to osteoporosis. Furthermore, the thesis shows that the functional tests and the risk factor questionnaire seem to be of limited value for identifying 8 people with a radius fracture, who are at risk of falling or have osteopenia or osteoporosis. If, in spite of this, functional tests on musculoskeletal function are considered for testing of functional ability in patients with a recent radius fracture, the one leg-rise test may be sufficient. There seems to be an increased mortality and morbidity necessitating inpatient care among patients with a recent radius fracture. The osteoporosis school had no significant effect on BMD, balance, muscle strength or falls in this thesis. Therefore, the lack of proven efficacy of the osteoporosis school for the secondary prevention of distal radius fractures highlights the need for more and long-term randomised controlled follow-up studies in this specific population.
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Filho, Antonio Tufi Neder. "Estabilidade de fraturas intra-articulares da extremidade distal do rádio utilizando placas volares bloqueadas com parafusos unicorticais e bicorticais." Universidade de São Paulo, 2017. http://www.teses.usp.br/teses/disponiveis/17/17142/tde-29032018-113034/.
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A alta frequência das fraturas da extremidade distal do rádio estimula o contínuo estudo e desenvolvimento dos métodos de tratamento, buscando melhor qualidade de vida com menos sequelas e limitações. A placa volar bloqueada tem se tornado o método de escolha no tratamento nos últimos anos. Menos morbidade e a reabilitação mais precoce têm aumentado muito a utilização dessas placas. Esse método, contudo, não é isento de complicações. As mais frequentes estão relacionadas aos tendões extensores. Tendinites e rupturas têm sido relatadas. Com o objetivo de se proteger os tendões extensores, estudos têm sugerido a utilização de parafusos unicorticais na parte distal da placa e recomendam que os mesmos tenham pelo menos 75% do comprimento do parafuso bicortical. Esses estudos são restritos a fraturas extra-articulares. Esta pesquisa objetivou estudar e comparar as propriedades mecânicas dos modelos fixados com placas volares utilizando parafusos unicorticais e bicorticais em fraturas intra-articulares da extremidade distal do rádio classificadas como AO 23C3 sob cargas fisiológicas e a possibilidade de recomendar o parafuso unicortical na prática clínica. Objetivou também comparar, pelo método dos elementos finitos, as tensões geradas nos modelos após diferentes carregamentos com validações realizadas com os resultados dos ensaios mecânicos. Foram avaliados 42 modelos divididos em seis grupos de sete modelos, três com parafusos unicorticais e três com parafusos bicorticais. Cada grupo foi submetido a um único tipo de ensaio: compressão axial, flexão dorsal e flexão volar. Foram feitos dois ensaios estáticos intercalados por um carregamento cíclico e por último um ensaio até a falência. Os resultados demonstraram similaridade entre os respectivos grupos e confirmaram nossas hipóteses de que: a) o comportamento mecânico do modelo utilizando parafusos unicorticais é equivalente ao modelo usando parafusos bicorticais; b) o carregamento cíclico afeta o comportamento mecânico dos modelos das fixações das placas volares bloqueadas na extremidade distal do rádio. A análise por elementos finitos mostrou que as fixações unicortical e bicortical não resultaram em qualquer região de concentração de tensão crítica, sendo as duas indicadas para a estabilização de fraturas do rádio.The high frequency of distal radius fractures stimulates the continuous study and development of treatment methods seeking a better quality of life and fewer sequels and limitations. The volar locking plate has become the chosen method for the treatment in recent years. The lower morbidity and earlier rehabilitation have greatly increased the use of these plates. This method, however, is not free from complications, the most common being related to extensor tendons. Tendinitis and rupture have been reported. In order to protect the extensor tendons, studies have suggested the use of unicortical screws in the distal part of the plate, and recommended that they be at least 75% of the length of the bicortical screw. These studies are restricted to extra articular fractures. This study aimed at studying and comparing the mechanical properties of the models fixed with volar plates using unicortical and bicortical screws in intra-articular fractures of the distal radius classified as AO 23C3 under physiological loads and the possibility of recommending the unicortical screw in clinical practice. The tensions generated in the models after different loads with validations performed with the results of the mechanical tests were also compared. We studied 42 models divided into six groups of seven models, three with unicortical screws and three with bicortical screws. Each group underwent a single type of test: axial compression, dorsiflexion and volar flexion. Two static tests were performed, intercalated by a cyclic loading, and finally a test until bankruptcy. Our results demonstrated a similarity between the respective groups and confirmed both our hypotheses that: a) the mechanical behavior of the model using unicortical screws is equivalent to the model using bicortical screws, and b) that the cyclic loading affects the mechanical behavior of the models of the fixations of the volar locked plates in the distal radius. The finite element analysis showed that the unicortical and bicortical fixations did not result in any regions of critical stress concentration, so they are both indicated for the stabilization of radius fractures.
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Braziulis, Kęstutis. "RANKOS BIOMECHANINĖS FUNKCIJOS ĮVERTINIMAS GYDANT STIPINKAULIO DISTALINĖS DALIES LŪŽIUS DELNINE RAKINAMA PLOKŠTELE." Doctoral thesis, Lithuanian Academic Libraries Network (LABT), 2014. http://vddb.library.lt/obj/LT-eLABa-0001:E.02~2014~D_20140618_233834-02153.
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Stipinkaulio distalinės dalies lūžiai yra vienas iš dažniausių kaulų ir raumenų sistemos pažeidimų. Literatūroje nurodoma, kad distalinės stipinkaulio dalies lūžiai yra 1/10 visų lūžių, kuriuos patiria vyresni nei 35 metų amžiaus asmenys. Apie 3 % pacientų, po šios traumos išlieka ilgalaikė negalia. Siekiant optimizuoti stipinkaulio distalinės dalies lūžių gydymą, buvo atliktas tyrimas, kuriame buvo iškelti trys uždaviniai. Vertinome 2 savaičių imobilizacijos įtaką rankos funkcijai, po stipinkaulio distalinės dalies lūžio ir osteosintezės delnine rakinama plokštele. Taip pat vertinome,radiologinio lūžio tipo, pagal AO klasifikaciją, įtaką rankos funkcijai. Sugijus kaului, tirta metalinių konstrukcijų pašalinimo įtaka rankos funkcijai. Vertinant rezultatus, nustatyta, kad riešo judesių amplitudė ir rankos funkcija tarp pacientų, patyrusių stipinkaulio distalinės dalies lūžį su poslinkiu ir operuotų delnine rakinama plokštele, kuriems buvo taikyta pooperacinė 2 savaičių riešo imobilizacija ir kuriems pooperacinė riešo imobilizacija nebuvo taikyta, nesiskyrė. Tiriamiesiems, patyrusiems C tipo lūžį pagal AO radiologinę klasifikaciją nustatyta prastesnė funkcija. Riešo judesių amplitudė ir rankos funkcija po delninės rakinamos plokštelės pašalinimo nepakito.Distal radius fracture is one of the most common injuries of the skeletal and muscular system. It has been reported in literature that distal radius fractures account for one-tenth of all the fractures experienced by people older than 35 years. Long-term disability remains in approximately 3% of patients after a distal radius fracture. In order to optimise treatment of distal radius fractures, a study with three objectives was performed. We evaluated the effect of immobilisation for the period of 2 weeks on the hand function after a distal radius fracture and osteosynthesis with a volar locking plate. The effect of the fracture type according to the AO classification on the hand function was also assessed. After the bone has healed, the effect of the removal of metal constructions on the hand function was evaluated. The analysis of the results demonstrated that there were no differences in the range of wrist motions and the hand functionbetween the patients after a displaced distal radius fracture operated with a volar locking plate and post-surgery immobilisation of the wrist applied for the period of 2 weeks and the patients who did not have post-surgery wrist immobilisation applied. A worse function was determined in the patients after type C fracture according to the AO radiological classification. The range of wrist motions and the hand function after the removal of a volar locking plate did not differ.
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Toro, Aguilera Álvaro. "Síntesis de radio distal con placa volar. Influencia del bloqueo en el ángulo de los tornillos." Doctoral thesis, Universitat de Barcelona, 2014. http://hdl.handle.net/10803/283469.
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El tratamiento de las fracturas del extremo distal del radio mediante placa volar es una de las técnicas más empleadas en la actualidad. El auge de placas bloqueadas de ángulo fijo presenta una serie de particularidades en comparación a las placas bloqueadas de ángulo variable ya existentes.
La hipótesis de trabajo se basa en que la placa volar de ángulo bloqueado tiene menores tasas de complicación y mejores resultados funcionales en comparación con las placas de ángulo variable.
El objetivo primario busca comparar la tasa de protrusión de los tornillos metafisarios mediante tomografía computarizada y valorar los resultados funcionales entre ambas placas.
Los objetivos secundarios pretenden determinar la frecuencia de lesiones tendinosas, pérdidas de reducción, tasa de complicaciones, proporción de consolidación, correcta reducción post-operatoria, protrusión dorsal múltiple y la longitud de los tornillos protruyentes de ambos sistemas. Del mismo modo, se estudió la relación protrusión dorsal-tamaño axial del radio, la relación orificio de la placa-riesgo de protrusión dorsal y la relación entre una correcta reducción post-operatoria y/o pérdida de reducción a los 6 meses de seguimiento con los resultados funcionales.
Se trata de un estudio clínico prospectivo de cohortes equivalentes doble ciego en el ámbito del sistema sanitario público de la provincia de Barcelona (Hospital General de Granollers). Tamaño total del estudio 80 pacientes, 40 pacientes por cohorte con ninguna pérdida en el seguimiento. Los pacientes fueron incorporados de manera secuencial y su seguimiento medio fue de 12 meses (8 mín. - 12 máx). La primera cohorte fue tratada con la placa volar bloqueada de ángulo variable (ITS, PROLock Distal Radius Plate). La segunda cohorte se trató con placa volar bloqueada de ángulo fijo (DVR, Johnson&Johnson-Biomet). El programa estadístico empleado fue el SPSS v.2.0. Las variables cualitativas se analizaron mediante el test T-Fisher o Chi-cuadrado según teoría estadística. Las variables cuantitativas consideradas paramétricas fueron analizadas mediante test t-Student.
De los resultados obtenidos se concluye:
- Ambas placas presentaron resultados equivalentes en cuanto a protrusión dorsal, articular y resultados funcionales.
- La placa de ángulo variable soportó, de manera estadísticamente significativa, mejor el colpaso de la altura radial y presentó menos complicaciones menores. Los tornillos de ángulo fijo protruyen dorsalmente con longitudes menores que los de ángulo variable. No se evidenciaron diferencias respecto a: lesiones tendinosas, complicaciones mayores, asociación de complicaciones, retirada de material, consolidación del foco, correcta reducción y protrusión dorsal múltiple.
- El tamaño o grosor extremos del radio distal no fue un parámetro crítico en el riesgo de protrusión dorsal. El mayor número de protrusiones se produjo en radios con un tamaño medio.
- En este estudio, se objetivó que la frecuencia con la que un tornillo protruye dorsalmente depende de la localización del orificio de la placa que se escoja. La mayoría de los tornillos que protruyeron correspondieron a los orificios más distales y radiales de ambas placas.
- Una correcta reducción post-operatoria no implicó mejores resultados funcionales.
- Existe una correlación negativa débil, estadísticamente no significativa, entre la pérdida de reducción a los 6 meses y un peor resultado funcional.INTRODUCTION: Numerous plate-screw designs have been used for the treatment of distal radial fractures in the last years. To date, there is no evidence of clinical superiority or reducing complications between the fixed-angle locking and variable-angle locking screws. The aim of this study was to asses if variable-angle was superior to fixed-angle locking plate-screw with respect to complications and clinical outcomes. MATERIAL AND METHODS: 2 prospective cohorts of 40 patients each with a surgical distal radius fracture were studied. The first cohort was treated with a variable-angle locking plate-screw (PROLock Distal Radius Plate, I.T.S.) and the second one with a fixed-angle locking plate-screw (DVR DePuy Synthes). Both cohorts are statistically equal in order of age, sex, wrist side, complexity (Frykman’s classification) and radius size measured with Lister’s CT length. All patients had a minimum follow of 6 months after surgery and all were studied by CT-scan at that time. Radiological findings where measured by two radiologists specialized in musculoskeletal system. All data follows parametric criteria, Student’s t-test was performed for quantitative variables and chi-square test and fisher’s exact test for qualitatives. RESULTS: Variable-angle plate had dorsal protrusion in 17 cases (42.50%) and joint penetration in 3 cases (7.50%). It’s clinical repercussion was in 3 (7.50%) and 0 (0.00%) patients respectively. There was no statistical differences against fixed-angle plate with 16 dorsal protrusions (40.00%) and 2 joint penetrations (5.00%) with clinical implication in 6 (15.00%) and 0 (0.00%) respectively. Functional 6 months outcomes were of 82.250 points in Mayo Wrist score for the variable-angle plate and 81.875 points for the fixed-angle plate. CONCLUSION: Our results show that both devices had equivalent rate of dorsal and articular protrusion and functional outcomes. However, the radial height was statistically better preserved in the variable-angle plate (p=0.002). Fixed-angle plate had a higher rate of minor complications (p=0.012). Secondary objectives reflect a descriptive dorsal protrusion-risk study in order to distal radius size and screw hole plate position. Finally, an accurate surgical reduction or a 6 months loss of reduction, did not impact to short term functional outcomes.
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Smith-Forbes, Enrique V. "EXPLORATION OF FACTORS ASSOCIATED WITH PATIENT ADHERENCE IN UPPER EXTREMITY REHABILITATION: A MIXED-METHODS EMBEDDED DESIGN." UKnowledge, 2015. http://uknowledge.uky.edu/rehabsci_etds/27.
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Adherence is considered a prerequisite for the success of exercise programs for musculoskeletal disorders. The negative effects of non-adherence to exercise recommendations impact the cost of care, and also treatment effectiveness, treatment duration, the therapeutic relationship, waiting times, the efficiency of personnel and use of equipment. Adherence to therapeutic exercise intervention is a multifaceted problem.
The World Health Organization (WHO) established the multidimensional adherence model (MAM). The MAM describes five interactive dimensions (socioeconomic, healthcare team and system, condition-related, therapy-related, and patient-related factors) that have an effect on patient adherence.
The first purpose of this dissertation was to explore the MAM dimension of condition-related factors to determine the Quick Disabilities of the Arm Shoulder and Hand (QDASH) minimal clinical important difference (MCID) for three distal upper extremity conditions. The second purpose was to explore the MAM dimension of personal factors to learn from individuals who expressed incongruence between their QDASH and GROC scores; how they described their perceived change in therapy. The third purpose was to explore the MAM dimension of therapy-related factors to examine the effect of patient-therapist collaborative goal setting on patient adherence to treatment and QDASH outcomes.
Results demonstrated in the first study that diagnosis specific MCID’s differed from the global MCID using multiple diagnoses. In the second study results demonstrated that patients expect to have a dedicated therapist who they can trust to work collaboratively with them to establish goals and spend time with them to achieve these goals. In the third study, our first hypothesis was not supported for all three measures of adherence. The median for home exercise program diary adherence was found to trend towards significance by 8.7 percent favoring the experimental group Mann-Whitney U (p < .100). Our second hypothesis was not supported. The experimental group receiving collaborative goal setting intervention had similar QDASH mean change scores 45.9±27.6 compared to the control group 46.1±23.8, Mann-Whitney U (p < .859).
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Kristin, Julia. "Vorhersagekraft der Versagenslast des distalen Radius mit Mikro-Computertomographie und Zweienergie-Röntgen-Absorptiometrie." Diss., lmu, 2007. http://nbn-resolving.de/urn:nbn:de:bvb:19-75895.
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Livani, Bruno. "Fraturas do terço distal do umero associada a parilisia radial : tratamento pela tecnica MIPPO." [s.n.], 2007. http://repositorio.unicamp.br/jspui/handle/REPOSIP/312285.
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Orientador: William Dias BelangeroTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas
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Resumo: O tratamento das fraturas do terço distal da diáfise do úmero associadas a lesão do nervo radial ainda é assunto de controvérsia. Especialmente nesta região o nervo pode estar comprimido ou encarcerado por fragmentos ósseos. A osteossíntese com redução indireta da fratura e fixação interna, nesses casos, pode resultar em lesão nervosa permanente. O autor descreve uma técnica cirúrgica com a utilização da placa em ponte, introduzida percutaneamente nessas situações específicas. Seis pacientes foram operados evoluindo com a consolidação da fratura e a recuperação neurológica num tempo médio de 03 meses. Nessa casuística a única complicação foi um caso de infecção com fístula na cicatriz distal que resolveu completamente com a retirada do material de implante
Abstract: Fractures of the distal third of the humerus may be complicated by complete lesions of the radial nerve which may be entrapped or compressed by bone fragments. Indirect reduction and internal fixation may result in a permanent nerve lesion. The author describe the treatment of these lesions by insertion of a bridge plate using the minimally-invasive percutaneous technique. Six patients were operated on and showed complete functional recovery. Healing of the fractures occurred at a mean of 2.7 months (2 to 3) and complete neurological recovery by a mean of 2.3 months (1 to 5). In one patient infection occurred wich resolved after removal of the implante
Doutorado
Pesquisa Experimental
Doutor em Cirurgia
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Troillet, Julien Paul. "Magnetresonanztomographische Studie zur altersabhängigen Abbildung der Wachstumsknorpel des distalen Radius des Pferdes unter besonderer Berücksichtigung des Epiphysenfugenknorpels." Doctoral thesis, Universitätsbibliothek Leipzig, 2011. http://nbn-resolving.de/urn:nbn:de:bsz:15-qucosa-69211.
Full textAbstract:
Magnetresonanztomographische Studie zur altersabhängigen Abbildung der
Wachstumsknorpel des distalen Radius des Pferdes unter besonderer
Berücksichtigung des Epiphysenfugenknorpels.
Es wurden magnetresonanztomographische Untersuchungen von 28
Gliedmaßenabschnitten des distalen Radius im Alter von zwei Tagen bis 17 Jahren
durchgeführt. Die Studie wurde an einem 1,5 Tesla Magnetom “Symphony“
(Siemens) in vier unterschiedlichen Sequenzen (T1-gewichtet T1w, T2-gewichtet
T2w, Protonendichte PD, T2 Double Echo in Steady State T2-dess) und zwei
Schnittebenen (dorsal, sagittal) durchgeführt. Die Darstellung der knorpeligen
Wachstumsregionen des distalen Radius mit besonderem Hinblick auf seine
Epiphysenfuge wurde deskriptiv erfasst und altersbedingte Unterschiede definiert.
Die durchschnittliche Dicke des sich darstellenden Epiphysenfugenknorpels wurde in
zwei Sequenzen (T1w und T2-dess) vermessen und in Bezug zu dem ansteigenden
Alter des Probenmaterials gesetzt.
Die Proben konnte man fünf Gruppen zuordnen. In Gruppe 1 konnten sowohl der
Wachstumsknorpel der distalen Ossifikationszentren als auch die knorpeligen Anteile
der Epi- und Apophysenfugen dargestellt werden. In der Gruppen 2 ließen sich die
Apo- und Epiphysenfugen darstellen, in Gruppe 3 nur die Epiphysenfugen. Gruppe 4
beschrieb partiell geschlossene Epiphysenfugen und in Gruppe 5 stellten sich nur
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noch Fugennarben dar. Eine alterskorrelierende Abnahme der mittleren Knorpeldicke
der Epiphyse konnte mittels Vermessungen der Knorpelschichten nachgewiesen
werden. Der hyaline Knorpel war mit den gewählten Sequenzen sehr gut beurteilbar.
Der Wachstumsknorpel der Epi- und Apophysen stellte sich in den T1w und PD mit
hell-intermediärer und in den T2w mit intermediärer Signalintensität dar. Die
knorpeligen Anteile der Epi- und Apophysenfuge wurden in T1w intermediär bis hellintermediär,
in T2w hell-intermediär und in der PD hell-intermediär bis hyperintens
dargestellt. Angrenzende Strukturen wie die subchondrale Knochenplatte und die
Mineralisationszone der Epiphysenfuge konnten in dunkel-intermediären bis
hypointensen Signalen abgebildet werden.
Die Magnetresonanztomographie (MRT) hat sich als geeignetes Verfahren erwiesen,
die knorpeligen Strukturen der Wachstumsregion des distalen Radius des Pferdes
bildlich wiederzugeben. Altersabhängige strukturelle Unterschiede konnten im MRT
dargestellt werden. Damit leistet die vorgestellte Studie einen wichtigen Beitrag über
die anatomischen Verhältnisse und deren physiologische Darstellung.
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Schäfer, Martin [Verfasser]. "Komplikationen nach winkelstabilen palmaren Plattenosteosynthesen am distalen Radius. Ergebnisse des DGU-Registers / Martin Schäfer." Düsseldorf : Universitäts- und Landesbibliothek der Heinrich-Heine-Universität Düsseldorf, 2013. http://d-nb.info/1036974480/34.
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Herzig, Daniela. "Mentales Training bei ruhiggestellter oberer Extremität (distaler Radius) - prospektiv-randomisierte Studie an 18 gesunden Probanden." [S.l. : s.n.], 2008. http://nbn-resolving.de/urn:nbn:de:bsz:289-vts-63150.
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Troillet, Julien Paul [Verfasser], Walter [Akademischer Betreuer] Brehm, Walter [Gutachter] Brehm, and Christoph [Gutachter] Lischer. "Magnetresonanztomographische Studie zur altersabhängigen Abbildung der Wachstumsknorpel des distalen Radius des Pferdes unter besonderer Berücksichtigung des Epiphysenfugenknorpels : Magnetresonanztomographische Studie zuraltersabhängigen Abbildung derWachstumsknorpel des distalen Radius desPferdes unter besonderer Berücksichtigungdes Epiphysenfugenknorpels / Julien Paul Troillet ; Gutachter: Walter Brehm, Christoph Lischer ; Betreuer: Walter Brehm." Leipzig : Universitätsbibliothek Leipzig, 2011. http://d-nb.info/1237818311/34.
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