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Fractures of the distal radius represent the most common fracture in elderly patients, and often indicate the onset of symptomatic osteoporosis. A variety of treatment options is available, including closed reduction and plaster casting, K-wire-stabilization, external fixation and open reduction and internal fixation (ORIF) with volar locked platin...
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Citations
... The majority of these injuries are 'closed', with no evidence of breach of the surrounding skin. 2 There appears to be a bimodal age distribution of distal radius fractures consisting of a younger group who sustains relatively high-energy trauma to the upper extremity and an elderly group who sustains both high-energy injuries and insufficiency fractures. 3 As life expectancy increase, the incidence of distal radial fractures can be expected to increase as well. Distal radius fracture is also frequently associated with low bone mineral density. ...
Introduction: Fractures of lower end radius are most common fractures of the upper extremity encountered in practice and constitute 17% of all fractures and 75% of all forearm fractures. These injuries account for approximately one sixth of all fractures seen and treated. In the words of Dr. Abraham Colles “this fracture takes place about an inch and a half above the carpal extremity of the radius and there is a 17% lifetime probability for distal radius fractures”. The majority of these injuries are 'closed', with no evidence of breach of the surrounding skin. Materials and Methods: A prospective study on cases of the fractures of the distal end of the radius, attending the Orthopaedics outdoor and the emergency services of Vinayaka Mission's Kirupananda Variyar Medical College and Hospital, Salem. The fractures were classified according to Modified AO Classification. 25 cases were followed at regular intervals and final assessment was done at 3 months (photographic plate 2). This study was conducted with detailed clinical and radiological analysis after surgical management of fractures of distal end of radius.
... 11 Several treatment procedures comprised closed manipulation and POP, percutaneous K-wire insertion, and open reduction and internal fixation (ORIF_ with Tplates. [12][13][14][15][16][17][18] For fractures of the distal radius, intraarticular treatment principles must be the same as any other joint injury. All displaced joint fractures require manipulation for functional restoration of radiocarpal and the radioulnar joints alike. ...
Objectives:
To determent the effectiveness of Rikli and Regazzoni three-column theory in treating intra-articular fractures of the distal radius with T-plate and K-wire in terms of functional outcome and fracture union.
Methods:
The cross-sectional study was conducted at the Department of Orthopaedic Surgery and Traumatology, King Edward University, Mayo Hospital, Lahore, Pakistan, from June 2013 to March 2017, and comprised patients aged 15-60 years having closed intraarticular fracture of the distal radius <1 month older. The subjects were divided into two group A, managed by percutaneous K-wire fixation, and group B, managed with open reduction and internal fixation using T-plates. Wound infection, supination and pronation, flexion and extension at the wrist joint, bone union and functionality were observed. All patients were followed up with intervals for 12 months in the out-patient department, and wound infection and supination and pronation of the forearm were observed clinically. Union was observed using the standard criterion, and function was evaluated using the Disabilities of Arm, Shoulder and Hand score. Data was analysed using SPSS 20.
Results:
Of the 60 patients, there were 30(50%) with mean age 48.83±11.11 years in group A, and 30(50%) with mean age 49.87±13.45 years in group B. Overall, there were 49(81.7%) males and 11(18.3%) females. There were 33(55%) cases with right side involvement, and 27(45%) had the left side involved. Functionality imprived significantly in both groups (p<0.05). Union was observed in all cases in both groups, while the mean duration in group A was 9.21±1.74 weeks, and in group B it was 9.87±2.14 weeks.
Conclusion:
Restoration of the three columns of distal radius could either be fixed with T-plates and K-wires because there was no significant difference between the two groups.
... Durch die knöcherne Stabilisierung kann eine Reduktion der Schmerzen und des Infektionsrisikos erreicht werden (50,0 %). Die Präferenz der Gipsschiene zur temporären Stabilisierung der oberen Extremität beruht insbesondere auf der vergleichsweise einfachen, sicheren und überall verfügbaren Anlage einer Gipsschiene oder eines Cast (Kunststoffgips) (Bartl et al., 2011;Horst & Jupiter, 2016;Kalbitz & Gebhard, 2016). Zudem ist die Anlage einer Gipsschiene bei vergleichbar effizienter Frakturruhigstellung (Krueger et al., 2013) deutlich zeit-und kostengünstiger als eine Operation (Bartl et al., 2011;Kalbitz & Gebhard, 2016 & Krettek, 2003;Scalea et al., 2000;Schwabe et al., 2010;Suzuki et al., 2010). ...
... Die Präferenz der Gipsschiene zur temporären Stabilisierung der oberen Extremität beruht insbesondere auf der vergleichsweise einfachen, sicheren und überall verfügbaren Anlage einer Gipsschiene oder eines Cast (Kunststoffgips) (Bartl et al., 2011;Horst & Jupiter, 2016;Kalbitz & Gebhard, 2016). Zudem ist die Anlage einer Gipsschiene bei vergleichbar effizienter Frakturruhigstellung (Krueger et al., 2013) deutlich zeit-und kostengünstiger als eine Operation (Bartl et al., 2011;Kalbitz & Gebhard, 2016 & Krettek, 2003;Scalea et al., 2000;Schwabe et al., 2010;Suzuki et al., 2010). Dies wird im Rahmen von Humerusschaftfrakturen dadurch begründet, dass die nur unzureichende Stabilität der Gipsschiene als externe Fixierung nicht ausreiche, um zusätzlichen Weichteilschaden zu verhindern oder Schmerzen zu reduzieren (Bleeker et al., 1991;Suzuki et al., 2010). ...
Die vorliegende Arbeit untersucht die Therapiekonzepte „early total care“ (ETC) und „damage control orthopaedics“ (DCO) bei der Behandlung 90 polytraumatisierter Patienten mit Verletzungen an der oberen Extremität in der Universitätsklinik Würzburg. Nach dem „first hit“ im Rahmen des Polytraumas kann der Organismus und das Immunsystem durch eine aufwendige Operation im Sinne eines „second hit“ überfordert werden. Ziel des DCO ist es den „second hit“ zu minimieren, indem initial nur die notwendigsten Behandlungen durchgeführt werden und keine vollständige Ausversorgung entsprechend ETC durchgeführt wird. Es werden Kriterien herausgearbeitet, welche relevant für die initiale Therapieentscheidung sind. Liegen eine hohe Verletzungsschwere (ISS), Kreislaufkomplikationen und eine niedrige Überlebensprognose nach dem RISC II sowie schwere begleitende Kopf-, Abdomen-, Becken- oder Wirbelsäulenverletzungen vor, werden die Verletzungen an der oberen Extremität nach DCO therapiert. Zudem wird für komplexe Verletzungen der oberen Extremität mit Gelenkbeteiligung, Bandschäden oder schwerem Weichteilschaden, welche zeitaufwendige und planungsintensive Operationsverfahren bedürfen, die DCO-Strategie favorisiert. Wenn die notwendige Lagerung des Patienten auf dem Operationstisch für die Ausversorgung der Verletzung an der oberen Extremität initial möglich ist, wird die obere Extremitätenverletzung nach ETC therapiert, insbesondere wenn eine schwere Verletzung an der oberen Extremität vorliegt. In der ETC-Kohorte ist kein Patient verstorben. Das schlechtere Outcome in der DCO-Kohorte liegt vor allem an der initial höheren Verletzungsschwere. Auf Grund der besseren tatsächlichen als erwarteten Mortalität kann DCO als eine erfolgreiche Therapiestrategie bei schwerverletzten Patienten angesehen werden. Jedoch kann die vorliegende Arbeit keinen Nachteil für die Patienten durch die ETC-Behandlung feststellen.
... Despite the considerable research in the area [8,10,13,[15][16][17][18], there is no certainty into which procedure to follow for wrist fractures [19][20][21]. The main tool to examine wrist fractures is through diagnostic imaging, e.g., X-ray or Computed Tomography (CT). ...
This paper investigates the classification of radiographic images with eleven convolutional neural network (CNN) architectures (GoogleNet, VGG-19, AlexNet, SqueezeNet, ResNet-18, Inception-v3, ResNet-50, VGG-16, ResNet-101, DenseNet-201 and Inception-ResNet-v2). The CNNs were used to classify a series of wrist radiographs from the Stanford Musculoskeletal Radiographs (MURA) dataset into two classes—normal and abnormal. The architectures were compared for different hyper-parameters against accuracy and Cohen’s kappa coefficient. The best two results were then explored with data augmentation. Without the use of augmentation, the best results were provided by Inception-ResNet-v2 (Mean accuracy = 0.723, Mean kappa = 0.506). These were significantly improved with augmentation to Inception-ResNet-v2 (Mean accuracy = 0.857, Mean kappa = 0.703). Finally, Class Activation Mapping was applied to interpret activation of the network against the location of an anomaly in the radiographs.
... Despite the considerable research in the area ( [8,10,13,[15][16][17][18]), there is no certainty into which procedure to follow for wrist fractures [19][20][21]. The main tool to examine wrist fractures is through diagnostic imaging, e.g., X-ray or Computed Tomography (CT). ...
This paper investigates the classification of radiographic images with eleven convolutional neural network (CNN) architectures (GoogleNet, VGG-19, AlexNet, SqueezeNet, ResNet-18, Inception-v3, ResNet-50, VGG-16, ResNet-101, DenseNet-201 and Inception-ResNet-v2). The CNNs were used to classify a series of wrist radiographs from the Stanford Musculoskeletal Radiographs (MURA) dataset into two classes - normal and abnormal. The architectures were compared for different hyper-parameters against accuracy and Cohen's kappa coefficient. The best two results were then explored with data augmentation. Without the use of augmentation, the best results were provided by Inception-Resnet-v2 (Mean accuracy = 0.723, Mean kappa = 0.506). These were significantly improved with augmentation to Inception-Resnet-v2 (Mean accuracy = 0.857, Mean kappa = 0.703). Finally, Class Activation Mapping was applied to interpret activation of the network against the location of an anomaly in the radiographs.
... The surgical procedure is far more complicated than manipulation, and can lead to serious complications [2], however, it is more reliable as a long term treatment as manipulations sometimes fail and then surgery is needed. Despite the considerable amount of research in these areas [1], [2], [4], [5], [13], [22], [23], there is no certainty into which procedure to follow for wrist fractures [14]- [16]. ...
... Despite considerable research [5][6][7][19][20][21][22], there is still ambiguity in the procedure to follow with Colles' fracture [23][24][25]. There is some evidence that the degree of initial deformity and other factors such as age, dependency, functional status and presence of osteoporosis and x-ray characteristics like axial shortening of bones [26,27] and angles of volar tilt [28] might predict instability [29][30][31][32][33]. ...
Fractures of the wrist are common in Emergency Departments, where some patients are treated with a procedure called Manipulation under Anaesthesia. In some cases, this procedure is unsuccessful and patients need to revisit the hospital where they undergo surgery to treat the fracture. This work describes a geometric semi-automatic image analysis algorithm to analyse and compare the x-rays of healthy controls and patients with dorsally displaced wrist fractures (Colles' fractures) who were treated with Manipulation under Anaesthesia. A series of 161 posterior-anterior radiographs from healthy controls and patients with Colles' fractures were acquired and analysed. The patients' group was further subdivided according to the outcome of the procedure (successful/unsuccessful) and pre- or post-intervention creating five groups in total (healthy, pre-successful, pre-unsuccessful, post-successful, post-unsuccessful). The semi-automatic analysis consisted of manual location of three landmarks (finger, lunate and radial styloid) and automatic processing to generate 32 geometric and texture measurements, which may be related to conditions such as osteoporosis and swelling of the wrist. Statistical differences were found between patients and controls, as well as between pre- and post-intervention, but not between the procedures. The most distinct measurements were those of texture. Although the study includes a relatively low number of cases and measurements, the statistical differences are encouraging.
... These fractures are associated with complications like loss of reduction, malunion, nonunion, deformity, subluxation and instability. [6][7][8] Various surgical treatment modalities are reported in literature. Open reduction and internal fixation (osteosynthesis) with a volar plate system have shown good results. ...
p class="abstract"> Background: The objective of the study was to evaluate the functional and radiological outcomes after open reduction with internal fixation of volar Barton’s fracture of the wrist and compare their outcomes.
Methods: Total of 30 cases of volar Barton fractures were operated by open reduction and internal fixation with plating. Mean follow up period was 6 months. Patients were assessed both radiological and functional outcome and compare between the two outcomes.
Results: All fractures were healed in a mean period of 7 weeks (range 6-9 weeks). The mean disabilities of the arm, shoulder and hand (DASH) score was 13.21 points (range: 10.3 to 30), thus confirming the patient’s good functional capacity. The higher the DASH score was (i.e. the worse the functional result), the smaller were the flexion (p=0.01), pronation (p=0.03), supination (p<0.0001) and radial deviation (p=0.005) of the wrist that underwent the surgical procedure after the fracture of the distal extremity of the radius. The radiological results were evaluated by modified Lidstrom criteria.
Conclusions: The radiographic results did not influence the DASH score. There was no statistical relationship between the DASH score and the radial height or the volar tilt or the radial tilt of the distal extremity of the operated radius.</p
... Despite considerable research outcomes [3,2,4,12,16] have been published on the appropriate treatment procedure according to fracture characteristics, the choice of treatment remains highly subjective to the X-ray interpretation by the radiologist and largely depends upon the available clinical information on a case basis. ...
Wrist fractures (e.g. Colles’ fracture) are the most common injuries in the upper extremity treated in Emergency Departments. Most patients are treated with a procedure called Manipulation under Anaesthesia. Surgical treatment may still be needed in complex fractures or if the wrist stability is not restored. This can lead to inefficiency in constrained medical resources and patients’ inconvenience. Previous geometric measurements in X-ray images were found to provide statistical differences between healthy controls and fractured cases as well as pre- and post-intervention images. The most discriminating measurements were associated with the texture analysis of the radial bone.
This work presents further analysis of these measurements and applying them as features to identify the best machine learning model for Colles’ fracture treatment diagnosis. Random forest was evaluated to be the best model based on validation accuracy. The non-linearity of the measurement features has attributed to the superior performance of an ensembled tree-based model. It is also interesting that the most important features (i.e. texture and swelling) required in the optimised random forest model are consistent with previous findings.
... This can easily cause distal radial shortening, decrease the palmar and ulnar inclination angles and cause uneven articular surface. These consequently cause secondary pain and joint dysfunction (2). ...
... This can easily cause distal radius shortening, decrease the palmar and ulnar inclination angles and uneven articular surface. These consequently cause secondary pain and joint dysfunction (2) . Plate fixation is increasingly being applied in the treatment of comminuted distal radius fractures, and short-term follow-up demonstrates satisfactory results (3) . ...
