OBJECTIVE: To investigate the effectiveness of distal radius core decompression in the treatment of chronic wrist pain caused by various etiologies. METHODS: A retrospective analysis was performed for the clinical data of 10 patients with chronic wrist pain treated with distal radial core decompression between January 2018 and December 2021. There were 6 males and 4 females with an average age of 37.4 years (range, 21-55 years). The disease duration ranged from 7 to 72 months, with an average of 26.5 months. Preoperative MRI examination showed that 10 cases had bone marrow edema at the distal radius on the affected side, and 8 cases had bone marrow edema in the carpal bones such as scaphoid and lunate bone. Among them, 3 patients had a history of wrist fracture, and 2 patients had Kienböck diseases (1 case each in stage ⅡB and stage ⅢA). Three cases were combined with triangular fibrocartilage complex (TFCC) type 1A injury. Two cases were combined with osteoarthritis, 1 of them was complicated with severe traumatic arthritis, the wrist arthroscopy showed that the TFCC was completely lost and could not be repaired, and the cartilage of the lunate bone and the ulnar head were severely worn.Visual analogue scale (VAS) score was used to evaluate the relief of wrist pain before operation, at 6 months after operation, and at last follow-up, and the range of motion of the affected wrist in dorsiflexion, palmar flexion, ulnar deviation, and radial deviation was measured. The degree of bone marrow edema was evaluated according to T1WI, T2WI, and STIR sequences of MRI. RESULTS: All the patients were followed up 12-22 months, with an average of 16.4 months. Except for 1 patient who experienced persistent wrist joint pain and limited mobility after operation, the remaining 9 patients showed significant improvement in pain symptoms and wrist joint mobility. The VAS score and range of motion of wrist dorsiflexion, palmar flexion, ulnar deviation, and radial deviation at 6 months after operation and at last follow-up were significantly improved when compared with those before operation, the VAS score and the range of motion of wrist ulnar deviation and radial deviation at last follow-up were further improved when compared with those at 6 months after operation, all showing significant differences ( P<0.05). There was no significant difference in wrist dorsiflexion and palmar flexion between at 6 months after operation and at last follow-up ( P>0.05). Bone marrow edema was improved in 6 patients on MRI at 6 months after operation, and was also improved in other patients at last follow-up. CONCLUSION For chronic wrist pain caused by a variety of causes, distal radius core decompression can directly reduce the pressure of the medullary cavity of the distal radius, improve the blood supply of the corresponding distal structure, significantly alleviate chronic wrist pain, and provide an option for clinical treatment.
Male ; Female ; Humans ; Adult ; Radius/surgery* ; Wrist ; Retrospective Studies ; Radius Fractures/surgery* ; Wrist Joint/surgery* ; Scaphoid Bone/surgery* ; Pain ; Arthralgia/complications* ; Arthroscopy ; Decompression ; Range of Motion, Articular ; Treatment Outcome

OBJECTIVE: The relationship between the distal screws and the wrist articular surface was assessed by the additional lateral oblique fluoroscopic view during the operation, and the dorsal tangential view of the wrist was used to observe whether the distal screw penetrated the dorsal cortex, so as to evaluate the clinical efficacy of the volar locking plate in the treatment of distal radius fractures. METHODS: From January 2020 to June 2021, 45 cases of fresh distal radius fractures were treated using the volar Henry's approach, including 20 males and 25 females, aged from 32 to 75 years old with an average of (52.4±8.1) years old. During the operation, they were divided into 2 groups according to the different intraoperative fluoroscopic views:the control group of 20 cases, treated with standard anteroposterior and lateral fluoroscopic view;25 cases in the observation group, additional lateral oblique fluoroscopic view and dorsal tangential view of the wrist were taken. The wrist joint function score and postoperative complications were evaluated at 6 weeks, 3 and 6 months after operation between two groups. RESULTS: All 45 patients were followed up and the duration ranged from 6 to 14 months, with an average of (10.8±1.7) months, all patients achieved bone union and the incision healed well. The incidence of postoperative complications in the observation group was lower than that in the control group, and the difference was statistically significant (P<0.05). In terms of Gartland-Werley score of wrist joint function, the score of wrist function in the observation group was (4.58±1.31) at 6 weeks, (2.98±0.63) at 3 months and (1.95±0.65) at 6 months post-operatively, which were better than those in the control group (6.32±1.96) at 6 weeks, (3.63±0.76) at 3 months and (2.43±0.73) at 6 months. The difference was statistically significant (P<0.05). In the observation group, 7/25 cases(28%) were found to have screw penetration during the operation by additional lateral oblique and dorsal tangential radiograph fluoroscopic views of wrist. CONCLUSION The addition of lateral oblique and dorsal tangential during the operation could improve the accuracy of distal screw placement, reduce postoperative complications, and achieve early functional exercise.
Male ; Female ; Humans ; Adult ; Middle Aged ; Aged ; Wrist Fractures ; Radius Fractures/surgery* ; Fracture Fixation, Internal/methods* ; Fluoroscopy/methods* ; Bone Plates ; Postoperative Complications

PURPOSE: Electric scooters (e-scooters) have become an increasingly popular mode of public transportation in recent years. As the incidence of related injuries rises, it is important to understand specific fracture patterns unique to e-scooters and electric bikes (e-bikes) to help guide management. The purpose of this study was to review the prevalence and describe specific fracture patterns of e-scooter and e-bike related injuries at the busiest level 1 trauma center in the borough of Manhattan. METHODS: Chart review to determine mechanism of injury was performed on all patients for whom an orthopedic consult was requested from 1/1/2021 to 12/31/2021. All patients whose injuries were sustained due to an e-scooter or e-bike were further reviewed for demographics, injury characteristics including fracture pattern, and definitive injury management. Any patients who had an orthopedic consult placed for a reason other than an acute injury were excluded. Descriptive statistics are reported as frequency (percentage) for categorical variables and means for continuous variables. RESULTS: Of the 1815 orthopedic consults requested, 1357 (74.8%) were for acute injury management. Of those with acute injuries, 119 (8.8%) sustained 136 e-scooter or e-bike related injuries. There were 92 (77.3%) males at an average age of (33.8 ± 15.7) years. Approximately one-fifth of all patients presented in June 2021 (26, 21.8%). There was a 9.2% rate of open fractures. The 136 injuries were evenly split between the upper and lower extremities, with 57 (47.9%) upper extremity, 57 (47.9%) lower extremity injuries, and 5 (4.2%) concomitant upper and lower extremity injuries. The most common fracture patterns were ankle fractures (16, 11.7%), followed by tibial shaft (14, 10.2%), tibial plateau (13, 9.5%), and radial head fractures (11, 8.0%). There was a 33.3% incidence of associated posterior malleolar fractures in the spiral tibial shaft fractures, 31.0% of posterior malleolar involvement and 18.8% of isolated vertical medial malleolar fractures in the ankle fractures, and 61.5% of posterior comminution in the tibial plateau fractures. CONCLUSION E-scooter and e-bike related injuries have a high incidence of tibial shaft fractures, ankle fractures, tibial plateau fractures, and radial head fractures. There should be a high index of suspicion for posterior and medial involvement in lower extremity fractures sustained due to e-scooter or e-bikes. Identifying specific fracture patterns seen in e-scooter and e-bike related mechanisms will help guide management of these injuries.
Male ; Humans ; Adolescent ; Young Adult ; Adult ; Middle Aged ; Female ; Ankle Fractures ; Trauma Centers ; Incidence ; Radial Head and Neck Fractures ; Tibial Plateau Fractures ; Retrospective Studies ; Tibial Fractures/complications* ; Radius Fractures

BACKGROUND: Although distal radius fractures (DRF) are common fractures, intra-articular comminuted DRF with volar free fragments are uncommon. There is considerable difficulty in the fixation of free fragments beyond the watershed line using the existing volar locking plate. We aimed to examine the efficacy and potential complications associated with the use of juxta-articular volar plates in intra-articular DRF accompanied by free fragments beyond the watershed line. METHODS: The patients were enrolled in a consecutive manner between 2007 and 2016. In cases of DRF with free fragments beyond the watershed line, we employed a 2.4-mm small fragment juxta-articular volar locking compression plate using a volar Henry approach. A total of 32 patients were included in this study. There were 15 males and 17 females with a mean age of 52.3 years (range, 33 to 69 years). The mean follow-up period was 14.5 months (range, 10 to 24 months). Preoperative radiographs and three-dimensional computed tomography images were used to analyze fracture patterns and assess the free fragments beyond the watershed line. The mean number of free fracture fragments beyond the watershed line was 2.33. Plain radiographs of immediate postoperative and last follow-up were used to confirm fracture union, incongruence, radial height, volar tilt, radial inclination, and arthritic changes. For functional assessment, we measured grip strength, range of motion (ROM), modified Mayo wrist score (MMWS) and determined Disabilities of Arm, Shoulder and Hand (DASH) scores at the last follow-up. Postoperative complications were monitored during the follow-up period. RESULTS: All patients obtained sound union without significant complications. At the last follow-up, 16 cases presented with an articular step-off of more than 1 mm (mean, 1.10 mm). The mean MMWS was 76.3 (range, 55 to 90), mean DASH score was 15.38 (range, 9 to 22), mean visual analogue scale score for pain was 1.2 and mean grip strength was 75.5% of the opposite side. The mean ROM was 74.3° for volar flexion and 71.5° for dorsiflexion. CONCLUSIONS: In cases of intra-articular DRF with free fragments beyond the watershed line, a volar approach with use of a juxtaarticular plate provided favorable outcomes without significant complications.
Arm ; Female ; Follow-Up Studies ; Hand ; Hand Strength ; Humans ; Intra-Articular Fractures* ; Male ; Postoperative Complications ; Radius Fractures ; Radius* ; Range of Motion, Articular ; Shoulder ; Wrist ; Wrist Joint

Radial head excision has always been a safe commonly used surgical procedure with a satisfactory clinical outcome for isolated comminuted radial head fractures. However, diagnosis of elbow instability is still very challenging and often underestimated in routine orthopaedic evaluation. We present the case of a 21-years old female treated with excision after radial head fracture, resulting in elbow instability. The patient underwent revision surgery after four weeks. We believe that ligament reconstruction without radial head substitution is a safe alternative choice for Mason III radial head fractures accompanied by complex ligament lesions.
Adult ; Elbow Joint ; injuries ; Female ; Fracture Fixation ; Humans ; Joint Instability ; therapy ; Lateral Ligament, Ankle ; surgery ; Radius Fractures ; complications ; diagnostic imaging ; surgery ; Tomography, X-Ray Computed

The distal radioulnar joint (DRUJ) is a complex structure that enables sufficient, painless forearm rotation and provides weight-bearing capabilities of the upper extremity. Arthritis of DRUJ is multifactorial; the most common causes are trauma, congenital anomalies, as well as degenerative and inflammatory diseases. Congenital etiologies, as well as degenerative and inflammatory causes of arthritis are more common in women. Conventionally, initial management of symptomatic DRUJ arthritis is nonsurgical; surgery is generally reserved for patients with refractory pain. Moreover, advanced arthritis arising from trauma can be prevented by early interventions in the form of corrective osteotomy for malunited distal radius and distal ulna fractures, repair/reconstruction of the triangular fibrocartilage complex, and ulnar shortening osteotomy. Although the outcomes are typically positive following excision of the distal ulna in definitive arthritis, postoperative complications, such as instability and impingement of the residual distal ulna stump, can be serious. Procedures managing unstable residual ulna include soft tissue stabilization techniques and DRUJ implant arthroplasty.
Arthritis* ; Arthroplasty ; Early Intervention (Education) ; Female ; Forearm ; Humans ; Joints* ; Osteotomy ; Pain, Intractable ; Postoperative Complications ; Radius ; Triangular Fibrocartilage ; Ulna ; Ulna Fractures ; Upper Extremity ; Weight-Bearing

No abstract available.
Carpal Bones/*injuries ; Female ; Fractures, Bone/*complications ; Hand Injuries/*complications ; Humans ; Male ; Radius Fractures/*complications

Aged, 80 and over ; Female ; Fracture Fixation ; adverse effects ; Humans ; Male ; Postoperative Complications ; etiology ; Radius Fractures ; surgery

OBJECTIVETo summarize our experiences in the treatment of type C3 (AO/OTA) distal radius fractures fixed with AO 2.4 mm locking plates combined with percutaneous pinning after manipulative reduction.

METHODSFrom May 2009 to March 2012, 19 patients (2 cases of both sides) with type C3 (AO/OTA) distal radius fractures were treated with volar locking plates combined with percutaneous pinning for distal radius after manipulative reduction. Among the patients, the average age was (45.3 ± 17.4) years old (ranged, 31 to 66 years old). The fracture were complicated with ulnar styloid fracture in 14 wrists and 6 wrists had distal radioulnar joint instability. All the patients had closed fracture and the mean duration was (6.7 ± 3.5) days (4.5 to 9 days). The Henry approach was applied to expose the fracture site. Joint capsule and ligaments were retained for indirect reduction. After indirect reduction, the poking reduction technique was used to correct the residual compression, and congruence of distal ulnar radial joint was verified under fluorscopic guidance. Styloid process was first pinned percutaneously and then AO 2.4 mm volar locking plate was used to support rigid fixation. The fractures complicated with distal radioulnar joint instability and ulnar styloid fracture were treated with forearm plaster support in supination for 6 weeks.

RESULTSNineteen patients (21 wrists) were followed up for an average duration of 10.5 months (ranged, 7 to 17 months). Radiographic bone union of distal radius was achieved in all cases, nonunion of the ulnar styloid occurred in 3 cases, and no distal radioulnar joint instability occurred. Tendon irritation was found in 2 cases and disappeared after the internal fixation was removed. The volar tilt, radial angle, radial length, incongruence of articular surface and distal radioulnar joint were observed at the follow-up. According to Batra and Gupta scoring system, 13 wrists were assessed to have a score of more than 80, 5 wrists 70 to 90, 3 wrists less than 70. Meanwhile, the subjective and objective evaluation was executed,range of motion of wrist, residual deformity and complications were observed. According to Sarmiento's modification of the system of Gartland and Werley, 17 wrists got an excellent result, 3 good and 1 fair.

CONCLUSIONType C3 (AO/OTA) distal radius fractures could be managed with manipulative reduction. Locking plate internal fixation combined with percutaneous pinning can offer enough support for early mobilization and rehabilitation, resulting in a better clinical outcome and satisfactory prognosis.

Adult ; Aged ; Bone Plates ; Fracture Fixation, Internal ; methods ; Humans ; Manipulation, Orthopedic ; methods ; Middle Aged ; Radius Fractures ; complications ; surgery

OBJECTIVETo study therapeutic effects of comprehensive traditional Chinese medicine therapy for preventing postsurgery stiffness after operation for terrible triad of the elbow.

METHODSFrom December 2008 to December 2013,32 patients with elbow triad were randomly divided into two groups: therapy group and control group. There were 17 patients in control group including 12 males and 5 females with a mean age of (41.0 ± 7.1) years old. The patients in control group were received the past procedure therapy. There were 15 patients in therapy group, including 10 males and 5 females with a mean age of (41.3 ± 7.6) years old. The patients in therapy group were received comprehensive traditional Chinese medicine therapy, including passive exercise training at early stage (0 to 2 weeks after operation), transition from passive to active exercise training at middle stage (3 to 4 weeks after operation), and active exercise training at late stage (5 to 12 weeks after operation). Other treatment methods, such as orally taking or externally use of Chinese herbal medicine, manipulation and physiotherapy, were used at all stages. The Mayo Elbow Performance Score, patient satisfaction and complications were evaluated and analyzed.

RESULTSAll the patients were followed up, and the mean duration was 7.5 months. There were no complications such as internal fixation loosing, obvious displacement fracture and heterotopic ossification occurred. The Mayo score and patient satisfaction in therapy group were higher than those in control group (t = 12.78, P = 0.00; χ2 = 8.719, P = 0.003). Seven patients needed reoperation in control group, compared with 1 patient in therapy group (χ2 = 4.626, P = 0.032).

CONCLUSIONThe comprehensive traditional Chinese medicine therapy is effective to prevent postoperative stiffness after operation for terrible triad of the elbow by using different methods at different stages, which is worthy of spread and application.

Adult ; Case-Control Studies ; Elbow Joint ; injuries ; physiopathology ; surgery ; Female ; Humans ; Joint Dislocations ; surgery ; Male ; Medicine, Chinese Traditional ; Middle Aged ; Movement ; Postoperative Complications ; prevention & control ; Radius Fractures ; surgery ; Ulna Fractures ; surgery