OBJECTIVE: To assess the maturation disparity of hand-wrist bones using the BoneXpert system and Greulich and Pyle (GP) atlas in a sample of normal children from China. MATERIALS AND METHODS: Our study included 229 boys and 168 girls aged 2-14 years. The bones in the hand and wrist were divided into five groups: distal radius and ulna, metacarpals, proximal phalanges, middle phalanges and distal phalanges. Bone age (BA) was assessed separately using the automatic BoneXpert and GP atlas by two raters. Differences in the BA between the most advanced and retarded individual bones and bone groups were analyzed. RESULTS: In 75.8% of children assessed with the BoneXpert and 59.4% of children assessed with the GP atlas, the BA difference between the most advanced and most retarded individual bones exceeded 2.0 years. The BA mean differences between the most advanced and most retarded individual bones were 2.58 and 2.25 years for the BoneXpert and GP atlas methods, respectively. Furthermore, for both methods, the middle phalanges were the most advanced group. The most retarded group was metacarpals for BoneXpert, while metacarpals and the distal radius and ulna were the most retarded groups according to the GP atlas. Overall, the BAs of the proximal and distal phalanges were closer to the chronological ages than those of the other bone groups. CONCLUSION: Obvious and regular maturation disparities are common in normal children. Overall, the BAs of the proximal and distal phalanges are more useful for BA estimation than those of the other bone groups.
Age Determination by Skeleton ; Asian Continental Ancestry Group* ; Bone and Bones ; Child* ; China ; Developmental Disabilities ; Female ; Hand ; Humans ; Metacarpal Bones ; Pattern Recognition, Automated ; Radiography ; Radius ; Ulna ; Wrist

Floating arm injury represents a common yet complicated injury of the childhood severely associated with limb deformation and even morbidity, if not precisely addressed and credibly operated. Here, we report a rare floating upper limb case of a 9-year-old boy with multiple injuries of ipsilateral proximal humeral, supracondylar and distal radial limb. This is the first report to document such a combined floating elbow and floating arm injury in the same limb. In this report, we discuss the surgical procedures used and recovery of the patient monitored to ascertain the effectiveness of the method in limb reorganisation.
Accidental Falls ; *Bone Wires ; Child ; Fracture Fixation ; Humans ; *Humeral Fractures ; Male ; Multiple Trauma ; Radiography ; *Radius Fractures ; *Upper Extremity/diagnostic imaging/injuries/surgery

OBJECTIVETo analyze the radiological parameters of the conservatively in treating distal radius fracture and investigate whether the final re-displacement can be predicted after primary reduction.

METHODSFrom January 2013 to June 2014,212 patients with distal radial fracture conservatively were treated in our hospital, 107 patients of them were excluded because of their incomplete radiological parameters;the remaining 105 patients were available for radiological were assessed after injury, there were 56 male patients and 49 female patients in this study, the average age of the patients was 51 years old (ranged from 22 to 80 years). According to AO classification, there were 47 cases of type A2 and C1, and 58 cases of type A3, C2, C3. All patients were treated by closed reduction and below-elbow cast immobilization for 4 to 6 weeks. All patients were followed up for 3 to 6 months (means 4.5 months) by X-ray, all fractures were healed. Standard AP and lateral radiographic examination was conducted before reduction and after reduction and bony consolidation,the dorsal angulation and the radial angle were measured at each time point. The linear regression was used for the analysis to find out whether the final re-displacement can be predicted after primary reduction.

RESULTSAmong 105 patients,the significant correlations were found for the dorsal angulation between the reduction time and the end time (r = 0.82) and for the radial angulation between the reduction time and end time (r = 0.85).

CONCLUSIONThe dorsal angulation and the radial angulation after complete healing can be predicted from linear the regression functions. Due to the possibility of predicting the end result, whether the fracture should receive further conservative treatment or surgical treatment can be decided immediately.

Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Male ; Middle Aged ; Predictive Value of Tests ; Radiography ; Radius Fractures ; diagnostic imaging ; therapy

PURPOSE: There remains uncertain whether to fix or not an ulnar styloid fracture acommpanied by distal radius fracture. Fixation might be required in cases of the fracture involving a fovea of ulnar head, an attachment site of deep triangular fibrocartilage, which is thought to be important to distal radioulnar joint stability. We analyzed a fovea involvement of an accompanied ulnar styloid fracture in patients with distal radius fracture by simple radiograph and three-dimensional computed tomography (3D CT). METHODS: We retrospectively reviewed 168 patients who underwent surgery with volar locking plate for distal radius fracture in our hospital from January 2005 to March 2015 and evaluated a fovea involvement of ulnar head by simple radiographs and 3D CT respectively, and compared. RESULTS: On simple X-ray, 64 cases (38%) were ulnar styloid fovea fractures; however, 21 cases of these revealed non-fovea fractures by 3D CT. And 7 out of 104 cases determined as non-fovea fracture by simple radiographs were diagnosed as fovea fractures by 3D CT. Sensitivity, specificity and accuracy of evaluation by simple radiograph were 86%, 82% and 83% respectively, when compared with those of 3D CT based evaluation. CONCLUSION: Accuracy of evaluating an accompanied ulnar styloid fovea fracture in patients with distal radius fracture by simple radiograph, when compared with 3D CT, was 83%; therefore, we recommend using the 3D CT based evaluation instead of simple radiograph based one for determination of fovea involvement of ulnar head.
Head ; Humans ; Joints ; Radiography* ; Radius Fractures ; Retrospective Studies ; Sensitivity and Specificity ; Triangular Fibrocartilage

BACKGROUND: To evaluate risk factors of redisplacement and remind surgeons of key factors regarding conservative treatment of distal radius fracture. METHODS: A total of 132 patients who received conservative treatment for distal radius fractures between March 2008 and February 2011 were included in this study. Radial inclination, radial length, volar tilting angle, ulnar variance, fragment translation, and presence of dorsal metaphyseal comminution were measured on the X-rays taken immediately after reduction, one week after injury during the first follow-up outpatient clinic visit, and after the gain of radiological union. Secondary displacement was defined as a loss of reduction during the follow-up period, and was divided into 'early' and 'late' categories. We analyzed the influence of initial displacement radiologic variables, dorsal cortex comminution, and patient age on the development of secondary displacement. RESULTS: Development of secondary displacement was significantly associated only with initial displacement radiologic variables (p < 0.001), development of the late secondary displacement was significantly associated with age (p = 0.005), and initial displacement radiologic variables were associated significantly with a serial increase in ulnar variance (p = 0.003). CONCLUSIONS: Greater displacement on the initial radiographs indicates a higher possibility of development for secondary displacement, and older patients had a higher probability of late secondary displacement development. Furthermore, dorsal comminutions did not affect secondary displacement directly.
Adult ; Aged ; Aged, 80 and over ; Cohort Studies ; Female ; Fracture Fixation, Internal ; Fractures, Comminuted/radiography/therapy ; Humans ; Male ; Middle Aged ; Prognosis ; Radius Fractures/epidemiology/radiography/*therapy ; *Splints ; Young Adult

BACKGROUND: It is not clear whether the pronator quadratus (PQ) muscle actually heals and provides a meaningful pronation force after volar plating for distal radius fractures (DRFs). We aimed to determine whether the length of the PQ muscle, which is dissected and then repaired during volar plating for a DRF, affects the forearm rotation strength and clinical outcomes. METHODS: We examined 41 patients who requested hardware removal after volar plating. We measured the isokinetic forearm rotation strength and clinical outcomes including grip strength, wrist range of motion, and disabilities of the arm, shoulder and hand (DASH) scores at 6 months after fracture fixation. During the hardware removal surgery, which was performed at an average of 9 months (range, 8.3 to 11.5 months) after fracture fixation, we measured the PQ muscle length. RESULTS: The average PQ muscle length was 68% of the normal muscle length, and no significant relationship was found between the PQ muscle length and the outcomes including isokinetic forearm rotation strength, grip strength, wrist range of motion, and DASH scores. CONCLUSIONS: This study demonstrates that the length of the healed PQ muscle does not affect isokinetic forearm rotation strength and clinical outcomes after volar plating for DRFs. The results of this study support our current practice of loose repair of the PQ that is performed by most of the surgeons to prevent tendon irritation over the plate, and suggest that tight repair of the PQ is not necessary for achieving improved forearm function.
Adult ; Aged ; Bone Plates ; Device Removal ; Female ; Forearm/physiopathology/surgery ; Fracture Fixation, Internal/*methods ; Hand Strength ; Humans ; Male ; Middle Aged ; Muscle Strength ; Muscle, Skeletal/physiopathology/*surgery ; Radius Fractures/radiography/*surgery ; Range of Motion, Articular ; Wound Healing ; Young Adult

BACKGROUND: Distal radius fracture is the most common fracture of the upper extremity, and approximately 60,000 distal radius fractures occur annually in Korea. Internal fixation with an anatomical volar locking plate is widely used in the treatment of unstable distal radius fractures. However, most of the currently used distal radius anatomical plate systems were designed based on the anatomical characteristics of Western populations. Recently, the Korean-type distal radius anatomical volar plate (K-DRAVP) system was designed and developed based on the anatomical characteristics of the distal radius of Koreans. The purpose of this study was to evaluate the preliminary results of the new K-DRAVP system, and to compare its radiologic and functional results with those of the other systems. METHODS: From March 2012 to October 2012, 46 patients with acute distal radius fractures who were treated with the K-DRAVP system at three hospitals were enrolled in this study. Standard posteroanterior and lateral radiographs were obtained to assess fracture healing, and three radiographic parameters (volar tilt, radial inclination, and radial length) were assessed to evaluate radiographic outcomes. The range of motion and grip strength, the Gartland and Werley scoring system, and the disabilities of the arm, shoulder and hand (DASH) questionnaire were used to assess clinical and functional outcomes. RESULTS: All radiologic parameters were restored to normal values, and maintained without any loosening or collapse until the time of final follow-up. Grip strength was restored to 84% of the value for the unaffected side. The mean range of motion of the wrist at final follow-up was restored to 77%-95% of the value for the unaffected side. According to the Gartland and Werley scoring system, there were 16 excellent, 26 good, and 4 fair results. The mean DASH score was 8.4 points. There were no complications after surgery. CONCLUSIONS: The newly developed K-DRAVP system could be used to restore and maintain good anatomical parameters, and provide good clinical outcomes with low complication rates. This system is a promising surgical option for the treatment of distal radius fractures in the Korean population.
Adult ; Aged ; Aged, 80 and over ; *Bone Plates ; Female ; Fracture Fixation, Internal/*instrumentation ; Humans ; Male ; Middle Aged ; Radius/radiography/surgery ; Radius Fractures/radiography/*surgery ; Range of Motion, Articular ; Republic of Korea ; Volar Plate

PURPOSE: Multiple hereditary exostoses of the forearm typically form in the distal ulna, causing disturbances in the growth of the ulna and functional disability. Multiple hereditary exostoses inhibit the growth of the ulna, leading to an acquisition of a varus deformity in the radius, which sometimes leads to dislocation of the radial head, the development of limitations in the pronation-supination of the forearm, and cosmetic problems. MATERIALS AND METHODS: We retrospectively reviewed the cases of four patients who had deformities of the forearm with radial head dislocation associated with multiple hereditary exostoses, and evaluated the radiologic and clinical results of excision of the osteochondromas from the distal ulna and gradual ulnar lengthening with an Ilizarov external fixator. RESULTS: Good clinical and radiological results were obtained after a mean follow-up of 25 months. At the most recent follow-up, radial bowing, ulnar shortening, carpal slip, and the pronation/supination arch of the forearm had improved. There was little change in terms of preoperative radial articular angle and the flexion/extension arch of the elbow by the most recent follow-up. CONCLUSION: Treatment of four forearms from four patients by excision of osteochondromas and gradual lengthening of the ulna with an Ilizarov external fixator spontaneously reduced dislocations of the radial heads without the need for any additional operative intervention. All patients were satisfied with the final results.
Adolescent ; Child ; Child, Preschool ; Exostoses, Multiple Hereditary/*radiography/surgery ; Female ; Humans ; Male ; Radius/radiography ; Retrospective Studies ; Ulna/radiography ; Young Adult

Isolated trochlea fracture in adults is a rare surgical entity as compared to its capitellar counterpart. It has been only mentioned sporadically in the literature as case reports. Fracture of the trochlea is accompanied by other elbow injuries like elbow dislocation, capitellum fracture, ulnar fracture and extraarticular condylar fracture. Here we report a unique case of isolated displaced trochlea fracture associated with fractures of the lateral end clavicle and the distal end radius. We propose a unique mechanism for this rare combination of injuries: typical triad of injury, i.e. fracture of the distal end radius with trochlea and fracture of the lateral end of the clavicle. Nonoperative treatment is recommended for undisplaced humeral trochlea fractures; but for displaced ones, anatomical reduction and internal fixation are essential to maintain the congruous trochlea-coronoid articulation and hence to maintain the intrinsic stability of the elbow.
Accidents, Traffic ; Adolescent ; Clavicle ; diagnostic imaging ; injuries ; Fracture Fixation, Internal ; methods ; Humans ; Humeral Fractures ; diagnostic imaging ; surgery ; Male ; Radiography ; Radius Fractures ; diagnostic imaging ; surgery

BACKGROUND: The purpose of this study was to investigate the frequency and distribution of associated carpal bone fractures (CBFs) in distal radial fractures (DRFs). METHODS: Three hundred and thirteen patients who underwent surgical treatment for DRFs between March 2007 and January 2010 were reviewed retrospectively. In this study, 223 patients who had preoperative computed tomography (CT) were included. We investigated the frequency and distribution of associated CBFs on CT scans. The relationship between the frequency of associated CBFs and patient factors such as age, gender, body mass index, and the mechanism of injury was assessed. RESULTS: CBFs were complicated in 46 of 223 DRFs (20.9%). The distribution of CBFs was 23 cases in the triquetrum, 16 in the lunate, 12 in the scaphoid, five in the hamate, and four in the pisiform. Among the 46 cases, a fracture of one carpal bone occurred in 36 cases, two in seven cases, three in two cases, and four in one case. In 10 of the 46 cases, associated CBFs occurred in more than two carpal bones. No significant differences were observed for age, sex, body mass index, or the mechanism of injury between patients with DRFs and CBFs and those without CBFs. CONCLUSIONS: Because CBFs that mainly occur in the proximal carpal row are complicated in DRFs at a relatively high frequency, assessment of carpal bones using CT scans is beneficial.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Carpal Bones/*injuries/radiography ; Female ; Fractures, Bone/*complications/radiography ; Hand Injuries/*complications/radiography ; Humans ; Male ; Middle Aged ; Radius Fractures/*complications/radiography ; Retrospective Studies ; Tomography, X-Ray Computed