Objectives. The purpose of this study was to evaluate the impact of multi-radius (MR, n=20) versus gradually reducing radius (GR, n=18) knee design on the kinematics and kinetics of the knee during level ground walking one year after total knee arthroplasty. Materials and Methods. Thirty-eight knees with end-stage knee osteoarthritis were examined before and one year after total knee arthroplasty. The groups consisted of subjects who had undergone total knee arthroplasty with a representative MR designed implant (B Braun-Aesculap Vega. ®. Knee System) and a representative GR designed implant (Depuy Attune. ®. Knee System) (Figure 1). The kinematic and kinetic parameters of knee varus angle, first peak knee adduction moment, sagittal plane knee excursion and extensor moment were evaluated during gait, as well as the spatiotemporal gait outcomes of walking speed, stride length, cadence, step length, the percentage of stance phase. Comparisons of preoperative and postoperative outcomes were done by the paired t-test. Independent t-test was also done to compare the postoperative outcomes of MR designed implant and GR designed implant. Results. In spatiotemporal parameters of GR implant group, there was an increase in walking speed, stride length and cadence (all p<0.05) and no change in step length and the percentage of stance phase postoperatively. GR implant group showed large reductions in varus angle and adduction moment (all p<0.001), a significant increase in extensor moment (p=0.01), and a small reduction in sagittal plane excursion (p=0.04) after surgery. In comparison of two groups at one year after surgery, there were no significant differences of all spatiotemporal, kinematic and kinetic parameters between two groups except varus angle. GR implant group showed more reduction in varus angle than MR implant group (p=0.01). Conclusions. Total knee arthroplasty performed with gradually reducing radius knee design reduces frontal plane loading patterns of knee varus angle and adduction moment and provided improvement in spatiotemporal parameters. Post-operatively there were no statistical differences between the MR implant group and the GR implant group in any of the kinematic and kinetic measures except knee varus angle during level ground walking

Long femoral nails for neck of femur fractures and prophylactic fixation have a risk of anterior cortex perforation. Previous studies have demonstrated the radius of curvature (ROC) of a femoral nail influencing the finishing point of a nail and the risk of anterior cortex perforation. This study aims to calculate a patients femoral ROC using preoperative XR and CT and therefore nail finishing position. We conducted a retrospective study review of patients with long femoral cephalomedullary nailing for proximal femur fractures (OTA/AO 31(A) and OTA/AO 32) or impending pathological fractures at a level 1 trauma centre between January 1, 2015 and December 31, 2020 with both full length lateral X-ray and CT imaging. Femoral ROC was calculated on both imaging modalities. Outcomes measured including nail finishing position, anterior cortex encroachment and impingement. The mean femoral ROC was 1026mm on CT and 1244mm on XR. CT femoral ROC strongly correlated with nail finishing point with a spearmans coefficient of 0.77. Additionally, femurs with a ROC <1000mm were associated with a higher risk of anterior encroachment (OR 6.12) and femurs with a ROC <900mm were associated with a higher risk of anterior cortex impingement (OR 6.47). To our knowledge this is the first study to compare a measured femoral ROC to nail finishing position. The use of CT to measure femoral ROC and to a lesser extent XR was able to predict both nail finishing position and risk of anterior cortex encroachment. Preoperative XRs and CTs were able to identify patients with a small femoral ROC. This predicted patients at risk of anterior cortex impingement, anterior cortex encroachment and nail finishing position. We may be able to select femoral nails that resemble the native femoral ROC and mitigate the risk of anterior cortex perforation

The radius has a sagittal and coronal bow. Fractures are often treated with volar anterior plating. However, the sagittal bow is often overlooked when plating. This study looks at radial morphology and the effect of plating the proximal radius, with straight plates then contoured plates bowed in the sagittal plane. We report our findings and their effect on forearm rotation. Morphology was investigated using fourteen radii. Attention was made to the proximal shaft of the radius and its sagittal bow, from this 6, 7 and 8 hole plates were contoured to fit this bow. A simple transverse fracture was then made at the apex of this bow. Supination and pronation was then compared when plating with a straight plate and a contoured plate. Ten cadavers had the ulna plating at the same level. The effect on rotation of fractures plated in the distal third shaft was also measured. A significant reduction in rotation was found, when a proximal radius fracture was plated with straight plate compared to a contoured plate: 10.8, 12.8, 21.7 degrees (p<0.05 for 6, 7, 8 hole plates). Forearm rotation was decreased further when a longer plate was used. Ulna or distal shaft plating did not reduce rotation. This study has shown a significant sagittal bow of the proximal shaft of the radius. Plating this with contoured plates in the sagittal plane improves rotation when compared to straight plates. Additional ulna plating is not a source of reduced forearm rotation

Fractures of the distal radius are common, and form a considerable proportion of the trauma workload. We conducted a study to examine the patterns of injury and treatment for adult patients presenting with distal radius fractures to a major trauma centre serving an urban population. We undertook a retrospective cohort study to identify all patients treated at our major trauma centre for a distal radius fracture between 1 June 2018 and 1 May 2021. We reviewed the medical records and imaging for each patient to examine patterns of injury and treatment. We undertook a binomial logistic regression to produce a predictive model for operative fixation or inpatient admission. Overall, 571 fractures of the distal radius were treated at our centre during the study period. A total of 146 (26%) patients required an inpatient admission, and 385 surgical procedures for fractures of the distal radius were recorded between June 2018 and May 2021. The most common mechanism of injury was a fall from a height of one metre or less. Of the total fractures, 59% (n = 337) were treated nonoperatively, and of those patients treated with surgery, locked anterior-plate fixation was the preferred technique (79%; n = 180). The epidemiology of distal radius fractures treated at our major trauma centre replicated the classical bimodal distribution described in the literature. Patient age, open fractures, and fracture classification were factors correlated with the decision to treat the fracture operatively. While most fractures were

Aims of study. To assess and compare the functional, radiological and cosmetic results as well as patient satisfaction in patients treated with the IMN Device Vs Volar Locking Plate. Method. All patients who presented to our institution with extra articular distal radius fractures and met the inclusion criteria were invited to take part in the study. The patients were randomly allocated to two groups, those who underwent intramedullary (IMN) distal radius fixation using the Sanoma Wrx Distal radius nail and those who underwent fixation using a volar locking plate. The patients were then followed up at 2 weeks, 6 weeks, 3 months, 6 months and 1 year. The radiological parameters, ie radial height, inclination and tilt were compared as well as the functional outcomes by means of DASH score. The range of motion of the wrist was compared as well as the scar size. Complications were reviewed. Results. We present our early results. Currently we have included 9 patients in the IMN group and 7 patients in the volar plate group with follow-ups longer than 3 months. Results show smaller scars (2.5 vs 6.7cm), comparable flexion and extension (40 vs 40 and 45 vs 40), slight improvements in pronation and supination (80 vs 75 and 85 vs 80) in the IMN compared to the volar plate. Radial and ulnar deviation is comparable. The radiological parameters showed slight improvements in the radial height (2.5 vs 2.2 mm), inclination (3.6 vs 3.2 degrees) and tilt 13,7 vs 12 degrees) with the IMN. Dash scores will be compared at 6 months. Conclusion. Intra medullary nailing of the distal radius seems to compare to volar plating in terms of radiological parameters and rotational stability but has the added benefit of early range of motion, minimal invasive technique, less post op pain and less complications such as tendon irritation. NO DISCLOSURES

Premature growth arrests are an infrequent, yet a significant complication of physeal fractures of the distal radius in children and adolescents. Through early diagnosis, it is possible to prevent clinical repercussions of the anatomical and biomechanical alterations of the wrist. Their true incidence has not been well established, and there exists no consensual systematic monitoring plan for minimising its impacts. The main objective was to evaluate the prevalence of growth arrests after a physeal distal radius fracture. The secondary objective was to identify risk factors in order to better guide clinicians for a systematic follow-up. All patients seen between 2014–2016 in a tertiary orthopaedic clinic were retrospectively reviewed. Inclusion criteria were (one) a physeal fracture of the distal radius (two) adequate clinical/radiological follow-up. Descriptive, Chi-square and binary logistic regression analyses were carried out using SPSS software. One hundred ninety patients (mean age: 12 ± 2.8 years) fulfilled the inclusion criteria. Forty percent (n=76) of the fractures were treated by closed reduction. Premature growth arrest was seen in 6.8% (n=13) and diagnosed at a mean of 10 months post trauma. The logistic regression showed that the initial translation percentage (>30%) (p 25) (p increase the risk of growth arrest. After adjusting for concomitant ipsilateral ulnar injuries, a positive association between physeal complications and fracture manipulation was detected (76.9%, p=0.03). A non-significant trend between premature growth arrest and associated ulnar injury was observed (p=0.054). No association was identified for trauma velocity, fracture type, gender and age, and growth complications. A prevalence of 6.8% of growth arrest was found after a physeal fracture of the distal radius. Fractures presenting with an initial coronal translation > 30% and/or angulation > 25 from normal, as well as those treated by manipulation, have been shown to be at risk for a premature growth arrest of the distal radius. This study highlights the importance of a systematic follow-up after a physeal fracture of the distal radius especially for patients with a more displaced fracture who had a closed reduction performed. An optimal follow-up period should be over 10 months to optimize the detection of growth arrest and treat it promptly, thereby minimizing negative clinical consequences

The aim of this study was to determine the floor and ceiling effects for both the QuickDASH and PRWE following a fracture of the distal radius. Secondary aims were to determine the degree to which patients with a floor or ceiling effect felt that their wrist was ‘normal’, and if there were patient factors associated with achieving a floor or ceiling effect. A retrospective cohort study of patients sustaining a distal radius fracture and managed at the study centre during a single year was undertaken. Outcome measures included the QuickDASH, the PRWE, EuroQol-5 Dimension-3 Levels (EQ-5D-3L), and the normal wrist score. There were 526 patients with a mean age of 65yrs (20–95) and 421 (77%) were female. Most patients were managed non-operatively (73%, n=385). The mean follow-up was 4.8yrs (4.3–5.5). A ceiling effect was observed for both the QuickDASH (22.3%) and PRWE (28.5%). When defined to be within the minimum clinical important difference of the best available score, the ceiling effect increased to 62.8% for the QuickDASH and 60% for the PRWE. Patients that achieved a ceiling score for the QuickDASH and PRWE subjectively felt their wrist was only 91% and 92% normal, respectively. On logistic regression analysis, a dominant hand injury and better health-related quality of life were the common factors associated with achieving a ceiling score for both the QuickDASH and PRWE (all p<0.05). The QuickDASH and PRWE demonstrate ceiling effects when used to assess the outcome of fractures of the distal radius. Patients achieving ceiling scores did not consider their wrist to be ‘normal’. Future patient-reported outcome assessment tools for fractures of the distal radius should aim to limit the ceiling effect, especially for individuals or groups that are more likely to achieve a ceiling score

Extensor tendon ruptures have been reported in up to 8.8% of patients after volar plating and long screws have been implicated. The dihedral dorsal surface of the distal radius hinders accurate screw length determination using standard radiographic views (lateral; pronation and supination). A ‘dorsal tangential’ view has recently been described, but has not been validated. To validate this view, we mounted a plate-instrumented sawbone onto a jig. Radiographs at different angles were reviewed independently by 11 individuals. Skyline views clearly demonstrated all screw tips, whereas only 69% of screw tips were identifiable on standard views. With screws 2mm proud of the dorsal surface, skyline views detected 67% of long screws (sensitivity). The best of the standard views achieved only 11% sensitivity. At 4mm long, skyline sensitivity was 85%, compared with 25% for standard views. At 6mm long, 100% of long screws were detected on skylines, but only 50% of 8mm long screws were detected by standard views. Inter and intra-observer variability was 0.97 (p=0.005). For dorsal screw length determination of the distal radius, the skyline view is superior to standard views. It is simple to perform and its introduction should reduce the incidence of volar plate-related extensor tendon rupture

Distal radius fractures are the most common upper extremity fracture. The incidence is significantly higher in elderly females with osteoporotic bone. When surgery is indicated, volar locking plates (VLPs) allow for rigid fixation particularly in comminuted fractures with poor bone quality. Although numerous studies have shown the importance of plate placement to avoid soft tissue complications associated with volar plate fixation, there has been little evidence on the anatomic fit of current VLPs. Moreover, the effect of gender differences in distal radius morphology on anatomic fitting of VLPs has not been studied. The aim of this study was to evaluate the gender difference in distal radius morphology and the accuracy of the fit of a current VLP to CT-based distal radius models. Segmented CT models of ten female (mean age, 89 ± 5 years), and ten male (mean age, 86 ± 4 years) cadaveric wrists were obtained. Micro-CT models of the DePuy-Synthes 4-hole extra-articular (EA) and 8-hole volar column (VC) distal radius VLPs were created. A 3D visualization software was used to simulate appropriate plate placement on to the distal radius models by a fellowship-trained hand surgeon. Volar cortical angles (VCA) of the medial, middle and lateral portion of the distal radius were measured and compared between genders. The accuracy of the fit of the two VLP designs were quantified using the percentage of the watershed line (WSL) overlapped by the plate (WSL overlap), the distance between the WSL and the most distal aspect of the posterior plate (prominence distance) and the percentage of contact between the plate and bone. There were statistically significant gender differences in medial, middle and lateral VCAs (p=.003 medial, p=.0001 middle, p=.002 lateral). VCA ranged from 28° to 36° in females and from 38° to 45° in males. The WSL overlap did not show statistically significant gender differences (male: 5.9%, female: 13.6%, p=.174). However, the difference in prominence distance between different genders approached statistical significance (male: 3.5mm, female: 2.6mm, p=.087). Contact mapping between the plate and bone did not demonstrate a perfect contact in any of our specimens. Thus, contact measurements were categorized into 0.1mm, 0.2mm, and 0.3mm threshold contacts. There were no statistically significant gender differences in any of the threshold categories (0.1mm: p=.84, 0.2mm: p=.97, 0.3mm: p=.99). Our results confirm that there are gender differences in distal radius morphology. Current plate designs incorporate a VCA of 25° which does not match the native VCA of the distal radius in males or females. Although the difference in prominence distance approached statistical significance, there were no statistically significant gender differences in the WSL overlap or the contact threshold values. This lack of statistical significance may be related to the small sample size. This study proposes novel methods of assessing the anatomic fit of current VLPs in a 3D CT-based model that may be used in future studies with a larger sample size. Moreover, this study demonstrated the importance of considering gender differences in distal radius morphology in the design of future generations of implants

Distal radius fractures are the most common upper extremity injury, and are increasingly being treated surgically with pre-contoured volar-locking plates. These plates are favored for their low-profile template while allowing for rigid anatomic fixation of distal radius fractures. The geometry of the distal radius is extremely complex, and little evidence within the medical literature suggests that current implant designs are anatomically accurate. The main objective of this study is to determine if anatomic alignment of the distal radii corresponds accurately with modern volar-locking plate designs. Additionally, this study will examine sex-linked differences in morphology of the distal radius. Segmented CT models of ten female cadaver (mean age, 88.7 ± 4.57 years, range, 82 – 97) arms, and ten male cadaver (mean age, 86 ± 3.59 years, range, 81 – 91) arms were created. Micro CT models were obtained for the DePuy Synthes 2.4mm Extra-articular (EA) Volar Distal Radius Plate (4-hole and 5-hole head), and 2.4mm LCP Volar Column (VC) Distal Radius Plate (8-hole and 9-hole head). Plates were placed onto the distal radii models in a 3D visualization software by a fellowship-trained orthopaedic hand surgeon. The percent contact, volar cortical angle (VCA), border and overlap of the watershed line (WSL) were measured. Both sexes showed an increase in the average VCA measure from medial to lateral columns which was statistically significant. Female VCA ranged from 28 – 36 degrees, and 38 – 45 degrees for males. WSL overlap ranged from 0 – 34.7629% for all specimens without any statistical significance. The average border distance for females was 2.58571 mm, compared to 3.52411 mm for males, with EA plates having a larger border than VC plates. The border distances had statistically significant differences between the plate types, and was approaching significance between sexes. Lastly, a maximum percent contact of 21.966 % was observed in specimen F4 at a 0.3 mm threshold. No statistical significance between plate or sex populations was observed. This study investigated the incoherency between the volar cortical angle of the distal radius, and the pre-contoured angle of volar locking plates. It was hypothesized that if the VCA measures between plate and bone were unequal then there would be an increase in watershed line overlap, and decrease in percent contact between the surfaces. Our results agreed with literature, indicating that the VCA of bone was larger than that of the EA and VC pre-contoured plates examined in this study. With distal radius fracture incidences and prevalence on the rise for elderly female patients, it is a necessity that volar locking plates be re-designed to factor in anatomical features of individual patients with a particular focus on sex differences. New designs should focus on providing smaller head sizes that are more accurately tailored to the natural contours of the volar distal radius. It is recommended that future studies incorporate expertise from multiple surgeons to diversify and further understand plate placement strategies

Perioperative glucocorticoids have been used as a successful non-opioid analgesic adjunct for various orthopaedic procedures. Here we describe an ongoing randomized control trial assessing the efficacy of a post-operative methylprednisolone taper course on immediate post-operative pain and function following surgical distal radius fixation. We hypothesize that a post-operative methylprednisolone taper course following distal radius fracture fixation will lead to improved patient pain and function. This study is a randomized control trial (NCT03661645) of a group of patients treated surgically for distal radius fractures. Patients were randomly assigned at the time of surgery to receive intraoperative dexamethasone only or intraoperative dexamethasone followed by a 6-day oral methylprednisolone (Medrol) taper course. All patients received the same standardized perioperative pain management protocol. A pain journal was used to record visual analog pain scores (VAS-pain), VAS-nausea, and number of opioid tablets consumed during the first 7 post-operative days (POD). Patients were seen at 2-weeks, 6-weeks, and 12-weeks post-operatively for clinical evaluation and collection of patient reported outcomes (Disabilities of the Arm, Shoulder and Hand Score [qDASH]). Differences in categorical variables were assessed with χ2 or Fischer's exact tests. T-tests or Mann-Whitney-U tests were used to compare continuous data. Forty-three patients were enrolled from October 2018 to October 2019. 20 patients have been assigned to the control group and 23 patients have been assigned to the treatment group. There were no differences in age (p=0.7259), Body Mass Index (p=0.361), race (p=0.5605), smoking status (p=0.0844), or pre-operative narcotic use (p=0.2276) between cohorts. 83.7% (n=36) of patients were female and the median age was 56.9 years. No differences were seen in pre-operative qDASH (p=0.2359) or pre-operative PRWE (p=0.2329) between groups. In the 7 days following surgery, patients in the control group took an average of 16.3 (±12.02) opioid tablets, while those in the treatment group took an average of 8.71 (±7.61) tablets (p=0.0270). We see that significant difference in Opioid consumption is formed at postoperative day two between the two groups with patients in the control group taking. Patient pain scores decreased uniformly in both groups to post-operative day 7. Patient pain was not statistically from POD0 to POD2 (p=0.0662 to 0.2923). However, from POD4 to POD7 patients receiving the methylprednisolone taper course reported decreased pain (p=0.0021 to 0.0497). There was no difference in qDASH score improvement at 6 or 12 weeks. Additionally, no differences were seen for wrist motion improvement at 6 or 12 weeks. A methylprednisolone taper course shows promise in reducing acute pain in the immediate post-operative period following distal radius fixation. Furthermore, although no statistically significant reductions in post-operative opioid utilization were noted, current trends may become statistically significant as the study continues. No improvements were seen in wrist motion or qDASH and continued enrollment of patients in this clinical trial will further elucidate the role of methylprednisolone for these outcomes

Clinically significant proximal junctional kyphosis (PJK) occurs in 20% of children treated with posterior distraction-based growth friendly surgery. In an effort to identify modifiable risk factors, it has been theorized biomechanically that low radius of curvature (ROC) implants (i.e., more curved rods) may increase post-operative thoracic kyphosis, and thus may pose a higher risk of developing PJK. We sought to test the hypothesis that EOS patients treated with low ROC (more curved rods) distraction-based treatment will have a greater risk of developing PJK as compared to those treated with high ROC (straighter) implants. This is a retrospective review of prospectively collected data obtained from a multi-centre EOS database on children treated with rib-based distraction with minimum 2-year follow-up. Variables of interest included: implant ROC at index (220 mm or 500 mm), patient age, pre-operative scoliosis, pre-operative kyphosis, and scoliosis etiology. In the literature, PJK has been defined as clinically significant if revision surgery with superior extension of the upper instrumented vertebrae was performed. In 148 scoliosis patients, there was a higher risk of clinically significant PJK with low ROC (more curved) rods (OR: 2.6 (95%CI 1.09-5.99), χ2 (1, n=148) = 4.8, p = 0.03). Patients had a mean pre-operative age of 5.3 years (4.6y 220 mm vs 6.2y 500 mm, p = 0.002). A logistic regression model was created with age as a confounding variable, but it was determined to be not significant (p = 0.6). Scoliosis etiologies included 52 neuromuscular, 52 congenital, 27 idiopathic, 17 syndromic with no significant differences in PJK risk between etiologies (p = 0.07). Overall, patients had pre-op scoliosis of 69° (67° 220mm vs 72° 500mm, p = 0.2), and kyphosis of 48° (45° 220mm vs 51° 500mm, p = 0.1). The change in thoracic kyphosis pre-operatively to final follow up (mean 4.0 ± 0.2 years) was higher in patients treated with 220 mm implants compared to 500 mm implants (220 mm: 7.5 ± 2.6° vs 500 mm: −4.0 ± 3.0°, p = 0.004). Use of low ROC (more curved) posterior distraction implants is associated with a significantly greater increase in thoracic kyphosis which likely led to a higher risk of developing clinically-significant PJK in EOS patients

Purpose. Intra-articular fractures of the distal radius are common injuries. Their pathogenesis involves a complex combination of forces, including ligament tension, bony compression and shearing, leading to injury patterns that challenge the treating surgeon. The contribution of the radiocarpal and radioulnar ligaments to articular fracture location has not previously been described. Computed tomography (CT) scanning is an important method of evaluating intra-articular distal radius fractures, revealing details missed on plain radiographs and influencing treatment plans. Methods. We retrospectively reviewed CT scans of acute intra-articular distal radius fractures performed in one institution from June 2001 to June 2008. Forty- five of 145 scans were deemed unsuitable due to poor quality or presence of internal fixation in the distal radius, leaving 100 fractures for review. Fracture line locations were mapped to a standardised distal radius model, and statistically analysed in their relationship to ligament attachment zones. Results. Distal radius articular fracture lines are significantly less likely to occur in the regions of ligament attachment. Conversely, fracture lines are more likely to occur in the gaps between major ligament attachments. Conclusion. Articular fracture locations in the distal radius are significantly related to radiocarpal and radioulnar ligament attachments. This may aid treating surgeons in understanding the personality of a fracture and the role of ligamentotaxis in fracture reduction

After a fracture of the distal radius, the bone segments may heal in a suboptimal position. This condition may lead to a reduced hand function, pain and finally osteoarthritis, sometimes requiring corrective surgery. The contralateral unaffected radius is often used as a reference in planning of a corrective osteotomy procedure of a malunited distal radius. In the conventional procedure, radiographs of both the affected radius and the contralateral radius have been used for planning. The 2D nature of radiographs renders them sub-optimal for planning due to overprojection of anatomical structures. Therefore, computer-assisted 3D planning techniques have been developed recently based on CT images of both forearms. The accuracy of using the contralateral forearm for CT based 3D planning the surgery of the affected arm and the optimal strategy for planning have not been studied thoroughly. To estimate the accuracy of the planned repositioning using the contralateral forearm we investigated bilateral symmetry of corresponding radii and ulnae using 3-dimensional imaging techniques. A total of 20 healthy volunteers without previous wrist injury underwent a volumetric computed tomography scan of both forearms. The left radius and ulna were segmented to create virtual 3 dimensional models of these bones. We selected a distal part and a larger proximal part from these bones and matched them with a mirrored CT-image of the contralateral side. This allowed estimation of the accuracy by calculation of relative displacements (Δx, Δy, Δz) and rotations (Δψx, Δψy, Δψz) required to align the left bone with the right bone segments as a reference. We also investigated the relationship between longitudinal length differences in radius and ulna and utilised this relationship to arrive at an optimal planning of the length of the affected radius after surgery. Relative differences in displacement and orientation parameters after planning based on the contralateral radius were (Δx, Δy, Δz): −0.81±1.22 mm, −0.01±0.64 mm, and 2.63±2.03 mm; and (Δψx, Δψy, Δψz): 0.13°±1.00°, −0.60°±1.35°, and 0.53°±5.00°. The same parameters for the ulna were (Δx,Δy, Δz): −0.22±0.82 mm, 0.52±0.99 mm, 2.08±2.33 mm; and (Δψx, Δψy, Δψz): −0.56°±0.96°, −0.71°±1.51°, and −2.61°±5.58°. The results also point out that there is a strong linear relationship between absolute length differences (Δz) of the radius and ulna among the individuals. Since we observed substantial length difference of the longitudinal bone axes of both forearms in healthy individuals, including the length difference of the adjacent forearm bones in the planning turned out to be useful in improving length correction in computer-assisted planning of radius or ulna osteotomies. The improved planning markedly reduces length positioning variability, (from 2.9± 2.1 mm to 1.5 ± 0.6 mm). We expect this approach to be valuable for 3-D planning of a corrective distal radius osteotomy. Awareness of the level of bilateral symmetry is important in reconstructive surgery procedures when the contralateral unaffected side is used as a reference for planning and evaluation. Bilateral asymmetry may introduce length errors into this type of preoperative planning that can be reduced by taking into account the concomitant ulnae asymmetry

Introduction. Getting the distal locking screw lengths right in volar locking plate fixation of distal radius is crucial. Long screws can lead to extensor tendon ruptures whereas short screws can lead to failure of fixation, especially if there is dorsal comminution of the fracture. The aim of our study was to determine the distal radius anatomy in relation to sagittal lengths and distance between dorsal bone edge and extensor tendons based on MRI scan. Method. One hundred consecutive MRI scans of wrist were reviewed by two of the authors on two occasions. All MRI scans were performed for different wrist pathologies except distal radius fractures or tumours. An axial image, two cuts proximal to the last visible articular surface, was selected. Sagittal length at 5 different widths, maximum volar width, radial overhang over distal radio-ulnar joint and the distance between dorsal bone edge and extensor tendons were measured. Results. A total of 120 MRI scans were included of which 74 were women and 46 were men. Mean volar width was 32mm and longest sagittal length was 22 mm (at Lister's tubercle). Length radial to Lister's tubercle was the shortest (17mm) and ulnar sides were 21mm and 29mm. Male measurements were mean 3mm longer than females. Mean radial overhang over DRUJ was 4mm. Distance from bone to tendons was within 2mm of dorsal radius edge. Conclusion. The study provides a reference guide to average screw lengths at different widths of distal radius in males and females. EPL tendon is closest to bone although all the extensor tendons are within 2mm of bone edge and carry a risk of injury from drill and screw placement. DRUJ is also at risk of injury if screws are placed within 4mm of ulnar edge of distal radius

Object. Although single-radius designs have theoretical advantages in some aspects, there has been a paucity of evaluation studies. The purpose of this study was to compare 10-year clinical, radiological, survivorship outcomes of single radius and multi radius posterior stabilized prosthesis in total knee arthroplasty(TKA) with Rheumatoid Arthritis (RA). Method. In this retrospective observational study, we reviewed 240 patients (240 knees) with RA who underwent TKA between Oct 2005 and Dec 2007: SR group (120 patients, 120 knees, Stryker Scorpio NRG) and MR group (120 patients, 120 knees, Depuy sigma RP). A 1 : 1 matched case control study was conducted in two groups which were similar in terms of age, gender, BMI, ASA classification and operation team. Mean follow-up periods were 10.73±1.13 (range: 8–13) years and 10.82±1.09 (range: 7–13) years. Results. In SR group, the mean HSS score improved significantly from 38.63±8.76 to 87.67±6.62, the mean VAS score decreased significantly from 7.37±0.24 to 0.45±0.12. the mean range of motion improved significantly from 105.52°±7.78°to 124.32°±8.12° (p<0.001). In MR group, the mean HSS score improved significantly from 38.75±8.34 to 89.29±5.21, the mean VAS score decreased significantly from 7.62±0.26 to 0.33±0.10. the mean range of motion improved significantly from 104.18°±7.62° to 122.52°±8.03°(p<0.001). (See Figure 1) Clinical and functional improvements had no significant differences between the two groups. 6 complications were noted in SR group, including 2 cases of prosthetic loosening, 1 case of periprosthetic osteolysis, 3 cases of periprosthetic bright lines.6 complications were noted in MR group, including 2 cases of prosthetic loosening and 4 cases of periprosthetic bright lines. No case of infection was observed in two groups. Survivorship using Kaplan-Meier survival analysis was 97.5% (95% confidence interval [CI]: 96.8–98.3%) for the SR at 10 years and 98.3% (95% CI: 97.3–99.5%) for the MR group at 10 years, with no significant difference (p=0.755). (See Figure 2). Conclusion. This study suggested that both single-radius and multi-radius posterior stabilized prostheses can lead to satisfactory outcomes for clinical function, radiological evaluation and survivorship among RA patients undergoing TKA, and no significantly clinical differences was shown in two types of prostheses

Purpose of study:. The treatment goals in diaphyseal radius fractures are to regain and maintain length and rotational stability. Open reduction and plating remains the gold standard but carries the inherent problems of soft tissue disruption and periosteal stripping. Intramedullary nailing offers advantages of minimally invasive surgery and minimal soft tissue trauma. The purpose of this study is to describe the results of locked intramedullary nailing for adult gunshot diaphyseal radius fractures. Methods:. A retrospective review of clinical and radiological records was performed on patients with intramedullary nailing of isolated gunshot radius fractures between 2009 and 2013. Results:. Twenty-two nails were inserted in 22 patients, all males with a mean age of 28.9 years (range 19–40). Follow-up was for an average period of 11 weeks (range 6–24). One patient had a median nerve palsy and 2 a posterior interosseous nerve palsy pre-operatively. All operations were performed within 3 to 12 days of the injury. No primary bone grafting was performed. All fractures united with the index procedure. Average time to union was 10 weeks (range 8–24). Fourteen patients (64%) had their radial bow restored and maintained; these patients had minimal comminution in the middle to distal third of the radius. The bow could not be satisfactorily restored in severely comminuted fractures in the proximal third of the radius. Using the Anderson classification outcome was excellent in 14 patients (64%), satisfactory in 6 (27%) and unsatisfactory in 2 (9%). There were no complications associated with the surgery and one patient required nail removal for implant migration. Conclusion:. Intramedullary nail fixation of gunshot radius fractures has shown promising results in our hands with no significant complications. The fracture site and zone of comminution directly influenced our ability to restore radial bow

Tendon injuries after distal radius fractures Introduction: Tendon injuries after distal radius fractures are a well-documented complication that can occur in fractures managed both operatively and non-operatively. The extensor tendons, in particular the extensor pollicis longus (EPL) tendon, can be damaged and present late after initial management in a cast, or by long prominent screws that penetrate the dorsal cortex and cause attrition. Similarly, a prominent or distally placed volar plate can damage the flexor pollicis longus tendon (FPL). The aim of our study was to evaluate the incidence of tendon injuries associated with distal radius fractures.

We conducted a single centre prospective observational study. Patients aged 18–99 who presented with a distal radius fracture between May 2018 to April 2020 were enrolled and followed-up for 24 months. Tendon injuries in the group were prospectively evaluated. Results: 199 patients with distal radius fractures were enrolled. 119 fractures (59.8%) had fixation and 80 (40.2%) were managed incast. In the non-operative group, 2 (2.5%) had EPL ruptures at approximately 4 weeks post injury. There were no extensor tendon ruptures in the operative group. In the operative group, there were 6 (5%) patients that required removal of metalware for FPL irritation. At the time of operation, there were no tendon ruptures noted. Within the operative group we evaluated plate prominence using a previously described classification (Soong et al.). 5 of the 6 patients (83%) with FPL irritation had Grade 3 prominence.

The incidence of both flexor and extensor tendon injury in our cohort was 4%, extensor tendon rupture was 1% and flexor tendon rupture was avoided by early metalware removal. This study demonstrates tendon injuries are not uncommon after distal radius fractures, and close examination and follow-up are necessary to prevent eventual rupture. Plate prominence at the time of fixation should be minimised to reduce the risk of rupture.

Purpose of Study:. To review the outcome of paediatric patients with radius and ulna fractures treated with titanium elastic nails. Description of methods:. Paediatric patients with radius and ulna fractures who fulfilled the criteria for TENS nailing were used. The criteria included failed closed reduction, instability (>15°angulation, >5°rotation) and open fractures. The patients were treated with retrograde TENS nailing of the radius and ulna. The patients were followed up at a paediatric orthopaedic outpatient clinic at 1, 3, 6 and 12 weeks with a final visit at 6 months. Data was collected at every visit looking at range of motion (pronation and supination), clinical and radiological signs of union and complications. Summary of results:. Over a 16 month period, 214 paediatric patients with radius and ulna fractures were seen and managed. Eleven of these patients were treated with TENS nails. The average age of the patient was 8.3 years. The average time to union was 8.5 weeks. The average range of motion at 6 months was pronation of 80°and supination of 73°. Two patients developed a compartment syndrome in the immediate post-operative period and were treated with a fasciotomy and skin grafting. No other complications were noted. Conclusion:. TENS nailing of paediatric radius and ulna fractures in unstable, irreducible and open fractures is a good treatment modality with good, early union of fractures and acceptable range of motion. It provides an excellent alternative to plating these fractures

Increased use of locking volar plates for distal radius fractures led to a number of reports in literature of flexor tendon injuries from impingement and attrition against hardware. Repair of the pronator quadratus is critical in preventing tendon injury. We present a pronator quadratus sparing approach to the distal radius. The senior author has used a pronator quadratus sparing lateral pillar approach for for the past five years. A lateral incision is used over the radial styloid. The first dorsal compartment is released and APL and EPB tendons retracted. The underlying brachio-radialis tendon and insertion fascia is split and the palmar portion elevated off the distal radius with the pronator quadratus as a single contiguous sheet. The distal edge of the pronator quadratus is elevated from the wrist capsule by sharp dissection. The radial artery is protected by the retracted tissue. Repair of the brachio-radialis tendon and insertion fascia is much more robust than that of the pronator quadratus covering the entire plate. Since 2004, the senior author has used the pronator quadratus sparing approach for volar plating of the distal radius, in 183 cases. At last follow-up there were no instances of flexor tendon injury, which was considered to be one of the outcome measures and end-points. There was no impingement in the first dorsal compartment, except in two cases of lateral pillar hardware impingement from additional lateral pillar plate fixation through the same approach. Nine cases had minor persistent superficial radial nerve parasthesia. One case had a superficial wound infection requiring drainage. The repaired pronator quadratus formed a barrier protecting the plate. The infection was aggressively treated and the plate left in situ for three months till fracture union. Cultures from the retrieved plate showed no organisms. Another implant had two of the locking screws back out. The pronator quadratus fascia was tented with an underlying haematoma. The fascia however only showed minimum screw penetration and no flexor tendon injury. Average wrist dorsiflexion was 72 deg and palmar flexion 65 deg. Average pronation was 81 deg and average supination 69 deg. Supination range was slow to recover in younger patients. One explanation could be the tight pronator quadratus repair. Average PRWE and DASH scores were 19. The quadratus sparing approach to the volar distal radius is easy to perform and protects the flexor tendons at the wrist. Cases demonstrated that an intact pronator quadratus can act as an effective barrier to prominent hardware and superficial infection. Supination range may be reduced by this approach due to a tight repair, though a palmar DRUJ capsule contracture may also be an explanation