Aims. The aim of this study was to report a complete overview of both incidence, fracture distribution, mode of injury, and patient baseline demographics of paediatric distal forearm fractures to identify age of risk and types of activities leading to injury. Methods. Population-based cohort study with manual review of radiographs and charts. The primary outcome measure was incidence of paediatric distal forearm fractures. The study was based on an average at-risk population of 116,950. A total number of 4,316 patients sustained a distal forearm fracture in the study period. Females accounted for 1,910 of the fractures (44%) and males accounted for 2,406 (56%). Results. The overall incidence of paediatric distal forearm fractures was 738.1/100,000 persons/year (95% confidence interval (CI) 706/100,000 to 770/100,000). Female incidences peaked with an incidence of 1,578.3/100,000 persons/year at age ten years. Male incidence peaked at age 13 years, with an incidence of 1,704.3/100,000 persons/year. The most common fracture type was a greenstick fracture to the radius (48%), and the most common modes of injury were sports and falls from ≤ 1 m. A small year-to-year variation was reported during the five-year study period, but without any trends. Conclusion. Results show that paediatric distal forearm fractures are very common throughout childhood in both sexes, with almost 2% of males aged 13 years sustaining a forearm fracture each year. Cite this article: Bone Jt Open 2022;3(6):448–454

Introduction: The distal forearm is the most common fracture site in children. The stresses from a fall on the outstretched hand are prone to result on a physeal or metaphyseal fracture of the distal radius. Fortunately subsequent growth disturbance is unusual. Our aim is to report the advantages or disadvantages of the Kapandji method compared with the crossed pin fixation. Materials and Methods: We reviewed 29 children brought to the operating room for reduction and percutaneous fixation of distal forearm fractures during the last 18 months. There were 23 boys and 6 girls aging between 4 and 15 years old. Fractures were classified in four general types: physeal, torus, greenstick and complete. Sixteen fractures were fixed using the Kapandji technique and 13 were fixed with crossed pins. Results: All patients recovered full range of motion. None of the fractures required open reduction. Pinning using the Kapandji technique was easier and took about 50% less of the operating time. Nevertheless we found that there was no leading criteria to decide which were the fractures that would need pinning after reduction. There was an incidence of 10% of superficial infections that subsided after removal of the wires with no further complications in both methods. Conclusions and Discussion: Radial collapse, loss of wrist motion, and distal radioulnar joint dysfunction, all common problems associated with distal radius fractures in the adult, are rarely seen after children’s distal radial fractures. Closed reduction is usually easy. Although the final results were the same comparing crossed pin fixation and the Kapandji method, the later proved to be easier and less time consuming in the operating room. For this reason we favour this type of fixation for the distal forearm fractures in children

PURPOSE: Patients who sustain fall-related distal forearm fractures are at risk to sustain new fractures later in life. Risk factors for falls such as low physical activity, impaired gait and neuromuscular function, and comorbidity are well known, as well as risk factors for fractures such as female gender, old age, low body mass index (BMI) and low mobility. Fracture prevention is often directed toward bone mass density treatment, but there is evidence that high level of physical activity reduces falls and therefore also reduces fractures. Health related quality of life (HRQoL) has become an important additional measure. The aims of this study were to evaluate the HRQoL, reported with EQ-5D and SF-12, in women who had sustained fall-related distal forearm fracture one year earlier and compare with Swedish normative data, and to physical performance and self-reported comorbidity. PARTICIPANTS: Sixty women with a fall-related distal forearm fracture were invited to examine health-related quality of life and physical performance at a mean time of 13 months after they had sustained their fracture (S.D. 1.6, range 10–17). The inclusion criteria were that they should be able to perform the physical tests and to understand verbal and written Swedish. Forty three women (72%), mean age 68 (SD 8.4, range 50–84), agreed to participate. METHODS: The women filled in two generic HRQoL-questionnaires; EQ-5D and SF-12. They self-rated their physical activity and reported ailments, which were regularly examined by a doctor, and intake of prescribed medication. They reported problems or difficulties from the locomotor system and depressive symptoms during the three last months. All women underwent physical performance tests; handgrip strength, one leg standing (OLS) and walking speed. Fisher’s exact test, Mann Whitney U test and Spearman’s rank correlation coefficient were used in the statistical analyses. RESULTS: In the younger women (age 50–59) the HRQoL was lower compared to Swedish normative data. The EQ-5D index and VAS scores correlated moderately to the physical component summary (PCS-12) of the SF-12 (rs=0.73 and rs=0.69, respectively). The correlation to the mental component summary (MCS-12) of the SF-12 was lower (rs=0.32 and rs=0.22, respectively). Women who reported comorbidity and low physical activity scored lower in the corresponding items of health in both questionnaires. CONCLUSIONS: Low results in HRQoL questionnaires in apparently healthy older women with fall-related distal forearm fracture may indicate underlying comorbidity, not captured by physical performance tests. We suggest that HRQoL questionnaires should be used in additional to physical outcome measures for this patient group. The use of HRQoL questionnaires to find patients for preventive measures of falls and fractures should be further explored

Introduction: We aimed to assess a simple radiological method of predicting redisplacement of paediatric forearm fractures. The Cast Index (CI) is the ratio of sagittal to coronal width from the inside edges of the cast at the fracture site. A CI of > 0.7 was used as the standard in predicting fracture redisplacement. The cast index has previously been validated in an experimental study. Methods: Case records and radiographs of 1001 children who underwent a manipulation under general anaesthesia for a displaced fracture of the distal forearm were studied. Redisplacement was defined as more than 15 degrees of angulation and/or more than 80 percent of translational displacement on check radiographs at 2 weeks. Angulation (in degrees) and translation displacement (in percentage) were measured on the initial and check radiographs. The CI was measured on postoperative radiographs. Results: Fracture redisplacement was seen in 107 cases at 2 week follow up. Of the 752 patients (75%) with a CI of less than 0.7 the displacement rate was 5.58%. Of the 249 patients (25%) with a CI greater than 0.7 the redisplacement rate was 26%. The CI was significantly higher in the redisplacement group. No statistically significant difference was seen for age, sex or ethnicity. Nor were statistical differences noted in initial angular deformity, initial displacement and seniority of the surgeon. Good intra and inter observer reproducibility was observed. There was no statistical difference in patients with a cast index between 0.7 and 0.8. Conclusion: The cast index is a simple and reliable radiographic measurement to predict the redisplacement of forearm fractures in children. Previous studies have used a CI of > 0.7 as the predictor of redisplacement although this study suggests a plaster with a CI of < 0.81 is acceptable. A high cast index is associated with redisplacement of fractures and should therefore be considered when moulding casts in distal forearm fractures

We aimed to assess a simple radiological method of predicting redisplacement of paediatric forearm fractures. The Cast Index (CI) is the ratio of sagittal to coronal width from the inside edges of the cast at the fracture site. CI of 0.7 was used as the benchmark in predicting fracture redisplacement. Case records and radiographs of 1001 children who underwent a manipulation under general anaesthesia for a displaced fracture of the distal forearm were studied. Redisplacement was defined as more than 15 degrees of angulation and/or more than 80 percent of translational displacement on check radiographs at 2 weeks. Angulation (in degrees) and translation displacement (in percentage) were measured on the initial and check radiographs. The Cast index was measured on the check radiographs. Good intra and inter observer reproducibility was observed for both these measurements. The cast index has been previously validated in an experimental study. The adequacy of reduction after manipulation was estimated by the postreduction translation and angulation of the radius and ulna in anteroposterior and lateral plain film radiographs. The 1001 patients who qualified for the study, fracture redisplacement was seen in 107 cases at the all important two week follow up. Seven hundred and fifty-two patients had cast indices of 0.8 or less whilst 249 had casting indices of 0.81 or more. In patients with cast indices of 0.8 or less, the displacement rate was only 5.58%. However, in patients with cast indices of 0.81 or more, the displacement rate was 26%. Initial displacement, angulation and the post manipulation cast index were the three factors which were significantly higher in the redisplacement group. No statistically significant difference was seen for age, sex or ethnicity. Nor were statistical differences noted in initial angular deformity, initial displacement and seniority of the surgeon. There was no statistical difference in patients with cast indices between 0.7 and 0.8. Cast index is a simple reliable radiographic measurement to predict the redisplacement of forearm fractures in children. A plaster with a CI of > 0.81 is prone to redisplacement. A high cast index is associated with redisplacement of fractures and should therefore be considered when moulding casts is distal forearm fractures

The aim of this study was to assess the usefulness of Cast index and an indigenously developed Gap index as measures of poor moulding of plaster. 20 cases of re-manipulation of distal third forearm fractures excluding growth plate injuries were compared with a control of 80 patients. 5 patients in the control group had an axial deviation of more than 10 degrees but were not remanipulated and therefore were included in the failure group. The gap index and the cast index of the two groups was compared as predictors of failure of conservative treatment. The groups were similar in terms of demography and post reduction alignment. There was a significant difference (< 0.001) in the Cast index and the Gap index of both the groups. The sensitivity of the Cast index (> 0.8) in predicting failure of plaster was 48% while that of the sum of Gap index (> 0.15) in AP & Lat view was 88%. Gap index was found to be more accurate (84%) than Cast index (78%) in predicting failure. The gap index is a better predictor of failure than the cast index. A quick assessment of these indices, especially by the less experienced surgeons, is a good practice before accepting any plaster following a manipulation of distal radial fractures. It would not only save the patient a second anaesthesia but also complications of a more extensive second procedure and of course hospital resources

We undertook a prospective, single blinded, randomized, controlled trial of one hundred children treated with either an above or below elbow cast for treatment of closed, distal third forearm fractures requiring reduction. The re-manipulation rate in the below elbow group was 2% (95%CI: 0–11%) compared to 6% (95%CI: 2–15%) in the above elbow group, p=0.62. Above elbow casts do not appear to improve fracture immobilization nor reduce the requirement for re-manipulation in pediatric distal third forearm fractures. Debate exists regarding the benefits of using below elbow casts instead of above elbow casts for maintaining reduction in pediatric distal third forearm fractures. The literature indicates a loss of reduction rate of 14.6% of children treated in an above elbow cast and 2.5% in those treated with a below elbow cast. We undertook a prospective, single blinded, randomized, controlled trial of one hundred children treated with either an above or below elbow cast for treatment of closed, distal third forearm fractures requiring reduction. Outcome measures included re-manipulation rate, fracture displacement during cast wear, and cast complications. One hundred patients were suitably enrolled; fifty-four received an above elbow cast, forty-six received a below elbow cast. The two groups were similar in terms of age and gender. The above elbow group contained a higher proportion of both bone fractures (41/54) than the below elbow group (27/46). There were no significant differences between the two cast groups in initial, post-reduction or cast-off fracture angulation; nor any difference in the amount of fracture displacement during cast wear. The number of cast complications was similar between the two groups. The re-manipulation rate in the below elbow group was 2% (95%CI: 0–11%) compared to 6% (95%CI: 2–15%) in the above elbow group, p=0.62. Above elbow casts do not appear to improve fracture immobilization nor reduce the requirement for re-manipulation in pediatric distal third forearm fractures. Funding Hip Hip Hooray, Saskatoon

Background: Distal forearm fractures are common in children. Many studies have described high failure rate when treated by closed reduction and immobilization in plaster cast. Loss of reduced position in the cast has been shown to be the most important factor leading to malunion and failure of the treatment. Treating these fractures by closed reduction and percutaneous Kirsch-ner (K-) wiring has been recommended. Objective: This study aims at determining the value of management of distal forearm fractures in children by closed reduction and percutaneous K-wiring in avoiding treatment failure and improving the final outcome. Material and methods: A series of 70 displaced distal forearm fractures in children was studied. These children were randomly allocated to one of two treatment groups: either manipulation and cast alone, or manipulation and percutaneous K-wiring with cast. Both groups were followed up until union occurred. Looking at the incidence of redisplacement, the radiological position at union, and the functional results four months after injury. Results: Redisplacement occurred in 8 out of 35 patients in the cast group (23%), compared to none in the K-wiring group (the difference was statistically significant).The quality of reduction was significantly better in the K-wire group, both initially and at union. Only 59 patients (84%) were reviewed 4 months after injury, none of the children in both groups had functional deficit

Objective: Osteoporotic fractures of the distal forearm are demanding in terms of operative therapy and implants used. Volar fixed angle plating has become a standard procedure for these fractures. Recently intra-medullary nailing was introduced in clinical practice for the use in distal radial fractures. This randomized multi-center study compares both fixation techniques in terms of clinical and radiological outcome as well as quality of life score. Material and Methods: Up to now a total of 85 patients with extra- and intraarticular unstable fractures of the distal radius were included. 53 patients (Targon DR®, B. Braun-Aesculap: n=24; 2.4 mm plate, Synthes: n=29) completed the 6 months follow-up. Follow up examinations included an osteodensitometry using pQCT, X-ray analysis and a detailed clinical function examination. In addition the SF36 questionaire for quality of life assessment was carried out. Results: The operation time for volar plating was significantly longer than for intramedullary nailing (50.3±20.2 min versus 40.2±13.4 min), as was the time in hospital (5.4±1.8 days versus 2.2±0.6 days) (MW±SD; p< 0.05; Student-t-Test, post hoc: Bonferonni). The Gartland an Werley function score averaged 2.7±1.1 versus 1.9±0.8 for volar plating in comparision to treatment with the Targon DR® nail and thus just failed to reach statistical significance (p = 0.052). Radiological Evaluation revealed bony healing in all patients of both groups. Radial length was maintained in all but one patient (96%) in the nailing group and all but 2 patients (93%) in the plating group. A loss of volar tilt −5°was seen in 1 patient in the nailing group (4%) and 3 patients in the plating group (10%). Of interest radiological signs of bony healing developed much faster after intramedullary nailing. The Quality of life as measured by the SF36 was minimaly diminished in both groups (body/social function: Targon DR®: 56.3±25.1/63.4±21.2 points − 2.4 mm plate: 52.8±23.3/60.5±23.3 points). Osteoporotic bone loss was detected in a total of 72% of patients. Osteoporosis had no adverse effects on bony healing or functional parameters. We encountered two complications. One mild CRPS (volar plating) and in one case paraesthesia of the R. superficialis n. radialis (intramedullary nailing). Conclusion: Both intramedullary nailing with the Targon DR® nail and volar plating using a 2.4 mm volar fixed angle plate allows stable fixation of osteoporotic distal forearm fractures. Lower operation time and minimally invasive operative procedure of intramedullary nailing is accompanied by faster mobilization

In combined high median and ulnar nerve injury, transfer of extensor digiti minimi (EDM) and extensor carpi ulnaris (ECU) nerve branches to restore intrinsic hand function is previously described. A segment of nerve graft is required in this operation. The aim of this study was to evaluate the feasibility of using the sensory branch of radial nerve (SRN) as an “in situ vascular nerve bridge'” (IVNB) instead of sural nerve graft. Twenty fresh cadavers were dissected. In proximal forearm incision, the feasibility of transferring the EDM/ECU branches to the distal stump of transected SRN was evaluated. In distal forearm incision, the two distal branches of the SRN were transected near the radial styloid process to determine whether transfer of the proximal stumps of these branches to the motor branches of the median (MMN) and ulnar (MUN) nerves is possible. The number of axons in each nerve was determined. The size of the dissected nerves and their location demonstrate that tension free nerve coaptation is easily possible in both proximal and distal incisions. Utilisation of the SRN as an IVNB instead of the conventional sural nerve graft has some advantages. Firstly, the sural nerve graft is a single branch and could be sutured to either the MMN or MUN, whereas the SRN has two terminal branches and can address both of them. Secondly, the IVNB has live Schwann cells and may accelerate the regeneration. Finally, this IVNB does not require leg incision and could be performed under regional anesthesia. The SRN as an IVNB is a viable option which can be used instead of conventional nerve graft in some brachial plexus or high median and ulnar nerve injuries when restoration of intrinsic hand function by transfer of EDM/ECU branches is attempted

Introduction:. Sinus histiocytosis with massive lymphadenopathy (SHML) also known as Rosai – Dorfman disease is a disease of bone marrow stem cell origin. It affects lymph nodes primarily. Solitary bone lesions are very rare and can cause diagnostic difficulty. Aim:. To increase the awareness of SHML as a cause of cystic bone lesions. Materials and methods:. A 2 year old presented with 4 months history of pain and swelling of the distal forearm. There was no history of tuberculosis or HIV disease. The swelling was 4 × 3 cm firm, non-fluctuant and slightly tender. There were no lymph nodes. Radiographs showed an oval cystic lesion expanding with a well-defined margin. The ulnar cortex was deficient. CT scan confirmed a cystic lesion with contents of granulation tissue. The Hb and WCC were normal, ESR 20 was, CRP<5 and mantoux was negative. At surgery the lesion was curretted. The contents resembled tuberculous granulation but there was no caseation. The borders were well formed, the ulnar cortex was deficient. Results:. The histology revealed granulation tissue with numerous large histiocytes and immuno chemistry confirmed Rosai Dorfman disease. Healing with sclerosis was seen at 6 months. Discussion:. Rosai Dorfman disease is a systemic disease of bone marrow stem cells and lymphadenopathy is the prominent manifestation. Only ±8% of cases have been reported with bone involvement and 4% of these had no lymphadenopathy. The lesions are cystic and medullary but cortical involvement can occur. Solitary ossseous lesions characterized by a background of histocytes without eosinophils can mimic Langerhans histocytosis, localized osteomyelitis, fibrous dysplasia, tuberculosis, simple or aneurysmal bone cysts and metastatic deposits. Conclusion:. Lesions of haematopoetic origin should be considered in the diagnosis of lucent bone lesions in children

Introduction. Two randomised trials concluded cast type (above or below elbow) makes no significant difference in the re-displacement rate of paediatric forearm fractures involving the distal third of the radius. This has not, however, led to the universal use of below elbow casts. In particular we noted one trial reported significant re-displacement in 40% or more of cases, which was much higher than we would expect. To review the radiological outcomes and need for re-manipulation of paediatric distal forearm fractures treated with closed manipulation under anaesthesia in our institution, in part for subsequent comparison with published results. All forearm fractures treated at a specialist children's hospital in one year were reviewed retrospectively. Based on the methodology of one trial, we included all fractures involving the distal third of the radius, with or without an ulna fracture, which underwent closed manipulation. Outcomes were radiological alignment using existing radiographs and need for re-manipulation. Cast type was at the discretion of the treating surgeon. The radiological criteria for re-displacement were based on published methodology. 79 children underwent manipulation, 71 receiving above elbow casts and 8 below elbow casts. Radiologically 21% of injuries treated in an above elbow cast re-displaced (15/71) compared to 38% of those in below elbow plasters (3/8). In 2 cases the re-displacement was treated with re-manipulation. The preference in our institution was clearly for above elbow casts in this injury pattern. The small number of below elbow casts in our series limits any comparisons. Our rate of re-displacement using above elbow casts was half that of one of the published studies, so the existing literature is not consistent with our experience

Introduction. Displaced distal radius fractures in children have been treated in above elbow plaster casts since the last century. Cast index has been calculated previously, which is a measure of the sagittal cast width divided by the coronal cast width measurement at the fracture site. This indicates how well the cast was moulded to the contours of the forearm. We retrospectively analysed the cast index in post manipulation radiographs to evaluate its relevance in redisplacement or reangulation of distal forearm fractures. Study Design. Consecutive radiographic analysis. Materials and methods. 156 consecutive paediatric patients (114M : 42F), with a mean age of 9.8 years (range 2-15 years), presenting with forearm fractures were studied. All patients were manipulated in OR and a moulded above elbow cast was applied. The cast index was measured on immediate post manipulation radiographs. Results. Displacement of the fracture within the original plaster cast occurred in 30 patients (19%), 22/114 males; 8/42 females. The cast index in the 30 patients requiring a second procedure (mean 0.92, SD=0.08) was significantly more than the cast index (mean 0.77, SD=0.07) in the others (p< .001). Discussion. A high cast index in post manipulation radiographs indicates increased risk of re-displacement of the fracture and these patients should be kept under close review. Conclusion. Cast index is a valuable tool to assess the quality of moulding of the cast following closed manipulation of distal radius fractures in children. The maximum acceptable cast index should be 0.82

Aims

Low-energy distal radius fractures (DRFs) are the most common upper arm fractures correlated with bone fragility. Vitamin D deficiency is an important risk factor associated with DRFs. However, the relationship between DRF severity and vitamin D deficiency is not elucidated. Therefore, this study aimed to identify the correlation between DRF severity and serum 25-hydroxyvitamin-D level, which is an indicator of vitamin D deficiency.

Aims

The distal radius is a major site of osteoporotic bone loss resulting in a high risk of fragility fracture. This study evaluated the capability of a cortical index (CI) at the distal radius to predict the local bone mineral density (BMD).

Aim: To review an uncommon deformity arising in four patients. Method: A clinical and radiological review. Abstract: We describe four cases of distal radial epiphyseal dysplasia associated with a localised area of cutis aplasia congenita (CAC) over the dorsum of the distal forearm. The cutis aplasia was diagnosed at birth in all cases, but the radial dysplasia was not recognised until presentation to our orthopaedic department between the ages of 5 and 10 years. Radial dysplasia describes a spectrum of osseous, musculotendinous, and neurovascular dysplasias of the pre-axial border of the upper limb, and is the most common form of longitudinal deþ ciency. Cutis aplasia congenita involves an ulcerated area lacking in normal skin formation, present at birth. The most common site is on the scalp, but it has been described on the extremities, and overlying embryological malformations. This association, the long-term implications and the requirement for follow-up until skeletal maturity have not previously been described. We emphasise the importance of continued monitoring of these patients as the effects of radial dysplasia did not become obvious for several years, and the potential beneþt from achieving early skin cover with grafting rather than allowing healing by secondary intention is discussed. It is important to increase awareness of this condition so that early orthopaedic and plastic surgical opinions can be sought, in order to reduce the disabling effect on the underlying radius. Conclusions: Heightened awareness and early treatment with monitoring is required

Objective: To review of an uncommon deformity arising in four patients. Method: A clinical and radiological review. Conclusions: heightened awareness and early treatment with monitoring is required. We describe four cases of distal radial epiphyseal dysplasia associated with a localised area of cutis aplasia congenita (CAC) over the dorsum of the distal forearm. The cutis aplasia was diagnosed at birth in all cases, but the radial dysplasia was not recognised until presentation to our orthopaedic department between the ages of 5 and 10 years. Radial dysplasia describes a spectrum of osseous, musculotendinous, and neurovascular dysplasias of the pre-axial border of the upper limb, and is the most common form of longitudinal deficiency. Cutis aplasia congenita involves an ulcerated area lacking in normal skin formation, present at birth. The most common site is on the scalp, but it has been described on the extremities, and overlying embryological malformations. This association, the long-term implications and the requirement for follow-up until skeletal maturity have not previously been described. We emphasise the importance of continued monitoring of these patients as the effects of radial dysplasia did not become obvious for several years, and the potential benefit from achieving early skin cover with grafting rather than allowing healing by secondary intention is discussed. It is important to increase awareness of this condition so that early orthopaedic and plastic surgical opinions can be sought, in order to reduce the disabling effect on the underlying radius

From January 2000 to March 2004 16 thumbs after total avulsion-amputation were replanted in our hospitals. In 15 cases this was successful. In one case the thumb was lost 28 hours after replantation. Mostly the amputation was in the region of the first phalanx or the IP-joint of the thumb. In all cases our operative procedure for this form of amputation was the reconstruction of the vessels with vein grafts after the osteosynthesis and the reconstruction of the tendons. The donorsite region for the grafts was in 12 cases the dorsal forefoot and in 4 cases the distal forearm. In none of these cases there was the possibility of reconstructing both arteries. Mostly only an anastomosis for one artery and one vein could be done. For none of these patients it was possible to reconstruct the nerves primarily. Until now transphers of neurovascular skinislands of longfingers, free nerve transplantations with coaptations to the proximal stump of the injured nerve, free nerve transplantations with coaptations to the trunk of the median nerve or in one case an end-to-side coaptation have been performed to achieve a resensibility of the thumbs. In one case a patient rejected an operative nervereconstruction, because a sprouting of the proximal stump of the injured nerve lead to a (reduced) sensibility of the thumb. In 4 cases a therapy to achieve a resensibility has so far not been carried out. After replantations of injured thumbs necroses of the skin in different kinds were noticed. In 4 cases secondary skinreconstructions were necessary. All 15 successful replanted thumbs achieved very good results concerning function, strength and patient’s satisfaction. Our results don’t agree with the mostly bad results after total avulsionamputations mentioned in literature. We think that the replantation after total avulsionamputation of the thumb has a high chance of being successful and can achieve very good longtime results

Aims: The aim of this study was to evaluate the use of external þxation in Collesñ fracture.Methods: The history of all patients with distal forearm fracture (n=257) treated in Kuopio University Hospital during the year 1992 were studied. Radiographs of patients over 15 years of age treated with external þxation were studied (n=31), but only Collesñ fractures with dorsal angle (n=20) were cross-examined with a control group of conservatively treated randomly selected patients with a similar fracture (n=17). Radial shortening, dorsal angle and radial inclination were measured from the radiographs. Results: 70% and 22% of the fractures were intra-articular in external þxation (EF) and control (C) groups, respectively. The studied parameters at baseline were only a little bit (NS) worse in the EF group than in the control group. After reduction, the loss of radial length and inclination were corrected signiþcantly better using EF than in conservative treatment group. However, only radial inclination was maintained signiþcantly better in EF group after the immobilisation period (5–7 wk). There were less complications and functional problems reported in the conservatively treated patients (8% of all cases) than in the patients treated with external þxation (23%). However, worsening in the anatomical reduction during conservative treatment was reported in 22–27% of all cases. Conclusions: Only loss of radial length and inclination can be reduced signiþcantly better with external þxation than using conservative treatment. There seems to be no reason to use external þxation to reduce dorsal angle only. External þxation leads more often to complications than conservative treatment

In the last few years the study of the biology of fracture repair processes has isolated chemical mediators that induce and modulate bone repair. In orthopaedic surgery and traumatology, in cases of unsuccessful fracture setting, loss of bone and in the treatment of bone cavities it is advisable to associate a biological substitute in order to restore bone continuity and to maintain the mechanical properties of the skeletal segment. Platelets contain several growth factors (PDGF, TGFβ, EGF, IGF) capable of stimulating the proliferation of mesenchymal and mature cells such as fibroblasts and osteoblasts. The autologous platelet gel is obtained by separating and concentrating platelets from 450 ml of a patient’s blood. This procedure is simple, with a low risk of infections. It is free of immunogenic risk and it is comparatively cheap, considering the risk connected with a possible graft of homologous bone or with the use of allo- or xenograft. From 2003 we applied autologous platelet gel in eight patients: two cases of humerus pseudoarthrosis for exposed and plurifragmentary fractures, one with vascular and nerve injury; one forearm infected pseudoar-throsis with loss of bone and soft tissues caused by local drug injections; one infected ulnar pseudoarthrosis for high energy exposed proximal forearm and elbow fracture; one distal radius non-union after sub-amputation of distal forearm; one distal radius resection for TGC and implant of allograft epiphysis; one massive osteomyelitis of entire forearm after exposed distal radius fracture; and one humerus fracture in re-implanted arm with elbow arthrodesis. The patients were treated with surgical curettage of bone, iliac bone graft and autologous platelet gel; two received a vascularised fibular graft, all stabilised with internal fixation and six stabilised also with external fix-ation. They were immobilised for a mean of 3 months; then with a partial tutor they started physiotherapy. At the follow-up they were evaluated clinically and radiologically and with the DASH score. None of the patients had local or general post-operative complications; X-ray showed the restoration of regular skeletal filling. Only in one case was bone reabsorption seen in the distal humerus. All patients were satisfied and four of them returned to their pre-surgical occupation. The results of this application are difficult to standardise because of the complexity of each case. Imaging techniques are currently the only means to validate the remodelling process and to demonstrate its faster pace with platelet gel application. We are satisfied by the use of autologous platelet gel as a possible co-treatment in cases characterised by multiple surgical treatments with inactive pseudarthrosis and osteoepenia. The application is also simple, and the cost is relatively low with respect to the results obtained