Aims

The aim of this study was to evaluate the kinematics of the elbow following increasing length of the radius with implantation of radial head arthroplasties (RHAs) using dynamic radiostereometry (dRSA).

Displaced distal radial fractures in adults are commonplace. Acknowledging that satisfactory radiographic parameters typically will beget satisfactory functional outcomes, management of these fractures includes a reduction followed by either cast/splint immobilisation or internal fixation. While we can generally rely on internal fixation to maintain the reduction the same is not true of cast immobilisation. There are, however, limited data defining the fate of a fracture reduction in those treated in a cast and up to the time of radial union. Traditional practice is to recommend six weeks of immobilisation. Our goal was to detail the radiographic patterns of change in the radiographic parameters of radial inclination (RI), ulnar variance (UV) and radial tilt (RT) over the first twelve weeks in women fifty years old and older who had sustained a displaced distal radial fracture.

We examined serial standard PA and lateral distal radius radiographs of 647 women treated by closed reduction and casting for a displaced fracture of the distal radius. Measurements of RI, UV and RT from standardised radiographs were made immediately post-reduction as well as, as often as possible/feasible, at 1,2,3,6,9 and 12 weeks post fracture. All measurements were made by the senior author (accuracy range: 2 degrees for RI, 1 mm for UV and 4 degrees for RT, in 75% of cases). The primary outcome measure was the change in fracture position over time. Secondary outcomes included changes related to age group; known bone density; the relation to associated ulnar fractures; and independence of the variables of RI, UV and RT.

The mean immediate post-reduction values for RI, UV and RT were 21 degrees, 1.5 mm, and −6 degrees, respectively. These all changed in the first six weeks, and did not in the second six week period. The mean change in RI was 3 degrees, 60% of the change occurring in the first week post-reduction; only 0.3 degrees of change was noted beyond three weeks. The mean UV increased by 2.2 mm over the first 6 weeks, 23% in the first week post reduction. The mean RT change of 7.7 degrees was also gradual over the first 6 weeks, with no significant change afterwards. The RI changes identified were not influenced by patient age, while UV and RT changes were greater in older groups. Those fractures of the distal radius associated with a distal ulnar shaft or neck fracture did not lose radial inclination over the study period.

We have defined patterns of loss of reduction that commonly occur post reduction of a displaced distal radius fracture in women fifty years and older. Such patterns ought to guide our closed management of distal radial fractures, whether by altering the duration or method of casting. Women fifty years old and older, and physicians alike, must be advised that conventional casting post distal radial fracture reduction unreliably maintains fracture reduction.

A larger radial tuberosity, and therefore a smaller radioulnar space, may cause mechanical impingement of the DBT predisposing to tear. We sought to investigate anatomic factors associated with partial DBT tears by retrospectively reviewing 3-T MRI scans of elbows with partial DBT tears and a normal elbow comparison group. 3-T MRI scans of elbows with partial DBT tears and elbows with no known pathology were reviewed retrospectively by two independent observers. Basic demographic data were collected and measurements of radial tuberosity length, radial tuberosity thickness, radio-ulnar space, and radial tuberosity-ulnar space were made using simultaneous tracker lines and a standardised technique. The presence or absence of enthesophytes and the presence of a single or double DBT were noted. 26 3-T MRI scans of 26 elbows with partial DBT tears and 30 3-T MRI scans of 30 elbows without pathology were included. Basic demographic data was comparable between the two groups. The tear group showed statistically significant larger mean measurements for radial tuberosity length (24.3mm vs 21.3mm, p=0.002), and radial tuberosity thickness (5.5mm vs 3.7mm, p=<0.0001. The tear group also showed statistically significant smaller measurements for radio-ulnar space (8.2mm vs 10.0mm, p=0.010), and radial tuberosity-ulnar space (7.2mm vs 9.1mm, p=0.013). There was a statistically significant positive correlation between partial DBT tears and presence of enthesophytes (p=0.007) as well as between partial DBT tears and having two discrete DBTs rather than a single or interdigitating tendon (p=<0.0001). Larger radial tuberosities, and smaller radio-ulnar and radial tuberosity-ulnar spaces are associated with partial DBT tears. This may be due to chronic impingement, tendon delamination and consequent weakness which ultimately leads to tears. Enthesophytes may be associated with tears for the same reason. Having two discrete DBTs that do not interdigitate prior to insertion is also associated with partial tears

Introduction: Fractures of the distal radius are amongst the most commonly encountered injuries in orthopaedic trauma. Treatment options include closed manipulation, percutaneous fixing using K wires and external fixation. Restoration of the volar tilt and radial length are proven to have a positive correlation with a good functional outcome. A randomised prospective study has been performed to compare the effectiveness of percutaneous stabilisation using K wires inserted in the traditional transcortical fashion with K wires inserted using a novel intramedullary spring loaded technique. The treatments were compared for their ability to restore normal anatomy, carpal alignment and function of the hand after unstable fractures of the distal radius. Patients and Methods: Between October 2001 and February 2002, 46 patients with unstable fractures of the distal radius were entered into the study. There were 37 females and 9 males, mean age of 58 years (range 17–87). Fractures were classified using the AO system. Patients were randomly allocated using closed envelopes into one of two groups. All fractures were reduced, and three 1.6mm K wires were inserted using one of two techniques. Group I (24 pts) had the wires engaged into the opposite cortex and driven down the medullary canal (spring-loaded). All patients were followed up for a minimum of 6 weeks. Radiological and functional evaluation was performed. Results: Immediate post operative radiographs showed a mean dorsal angle of –3° in Group I (ie 3 degrees volar tilt) and –7.5° in Group II. Restoration of radial length was similar in both groups. By 6 weeks, the mean dorsal angle for Group I was −1.9°, and –10.6° in Group II. The mean loss of radial length was similar in both groups (1.2mm in Group I; 1.3mm in Group II). Functional outcome was assessed using the Wrist Function Score. 2. , and was similar in both groups at 6 weeks. There were 2 early fixation failures, both in Group I, and both class C3 fractures (AO). Conclusion: ‘Spring loaded’ percutaneous K wiring of distal radius fractures results a significantly superior restoration of volar tilt post operatively and at 6 weeks when compared against the transcortical technique. The ‘spring’ translates into a dynamic force reducing the fracture. We estimate that these radiological results will result in a superior functional outcome in the longer term

Introduction. The classical Colles fracture (extraarticular, dorsally angulated distal radius fracture) in patients with osteoporotic bone is becoming increasingly more frequent. There still appears to be no clear consensus on the most appropriate surgical management of these injuries. The purpose of this study is to appraise the use of percutaneous extra-focal pinning, in the management of the classical colles fracture. Methods. We retrospectively analysed 72 consecutive cases of Colles fractures treated with interfragmentary K-wire fixation, in female patients over sixty years of age, in two orthopaedic centres, under the care of twelve different orthopaedic surgeons. We correlated the radiographic distal radius measurements (ulnar variance, volar tilt, and radial inclination) at the pre-operative and intra-operative stages with the final radiographic outcome. Result. Mean dorsal angulation was 21° at time of presentation. Closed reduction significantly improved fracture position to a mean of 2.7° volar angulation (p<0.05). Mean angulation at time of k-wire removal was 1.6° dorsal, this was not significant in comparison to post reduction measurements (p< 0.05). Mean ulnar variance at time of presentation was 2.5mm (range 7.4 to -4.2). Reduction improved fracture displacement to a mean of 0mm, which was statistically significant (p<0.05). Mean ulnar variance at time of k-wire removal was 2.4mm (p<0.05). 56.8% of cases demonstrated radial shortening of 2mm or more. Conclusion. In female patients over 60 years of age, the best predictor of radial length, when K-wire fixation is to be used, is the radial length prior to fracture reduction. Thus if there is radial shortening visible in the initial radiographs as measured in terms of ulnar variance, one should consider a method of fixation other than inter-fragmentary K-wires

Aims. To study the outcomes of DVR plating for distal radius fractures. Methods. We prospectively studied all patients managed with a DVR plate, over a twelve-month period in 2006/07. All patients were seen in our dedicated research clinic at 2, 6, 12 and 26 weeks post-operatively. Physiotherapy started at 2 weeks post-operatively. Active range of motion (ROM) of the injured wrist was recorded at 6, 12 and 26 weeks and compared with the normal side. Standardised radiographs were taken at 2 and 6 weeks and compared with pre- and post-operative films for radial and volar angulations, relative radial length, ulnar variance and implant position. Patient satisfaction was measured with the Patient Rated Wrist Evaluation score (PRWE) at 6, 12 and 26 weeks. Results. 129 patients (male:female 1:3) with a median age of 59 years (92-17 years) were seen. Mean measurements of pre-operative films were of 16 degrees dorsal angulation, 15 degrees radial inclination, 7 mm relative radial length and +2mm ulnar variance. In comparison post-operative results were -6 degrees, +22 degrees, 11mm and 0mm respectively, which remained unchanged at 2 and 6 weeks. The mean comparative active ROM was 70%, 88% and 98% at 6, 12 and 26 weeks respectively. The PRWE Score showed a mild degree of disability at 6 weeks and only minimal disability at 12 and 26 weeks. There were two cases of lost fracture position and no case of deep infection. Conclusion. Our study suggests that the DVR locking plate provides excellent fracture stability, allowing for early rehabilitation, with minimal complications. Radiological measurements were markedly improved and this correlated with a good ROM and high patient satisfaction. We recommend the use of the DVR plate to manage unstable distal radius fractures

Aim: To demonstrate that early open reduction and dorsal wedge corticocancellous bone grafting is an effective modality of treatment in the younger population with inherently unstable distal radial fractures sustained by high energy trauma. Methods: 17 patients with an average age of 53.7 years sustaining Frykman grades VII and VIII underwent open reduction and dorsal wedge cortico-cancellous bone grafting between 1994 and 1998. The study included eight men and nine women; the right wrist being affected in eight cases and the left in nine. There was dorsal comminution in 10 wrists with additional volar comminution in the remaining 7 cases. The mean time to operation was 6.5 days and the time to review averaged 16.5 months. Results: Good functional outcome results with a mean mass grip strength of 68.8% (Range = 40 to 100%) and patient satisfaction (94%) were obtained. A signiþcant improvement of radiographic parameters were observed postoperatively (Mean radial length = 11.7mm; Mean volar tilt = + 1.4¡) and remained so at the time of assessment (Mean radial length = 11.0mm; Mean volar tilt = -0.1¡) indicating structural support of the cortico-cancellous graft. Conclusion: Open reduction and dorsal wedge cortico-cancellous bone grafting is an effective modality of treatment of unstable fractures of the distal radius in the younger population. Donor site morbidity was not a disadvantage

Purpose: The retrospective evaluation of long-term results after reconstructive radial osteotomy for mal-united distal radius fractures. Material-Method: Twenty-eight patients (21 male and 7 female, average aged 46 years) with 23 dorsal and 5 palmar angulated malunited distal radius fractures were operatively treated during 1994–2002 in our department. The main indications were pain and functional impairment. Dorsal or palmar approach was used in proportion to the site of angulation. The preoperative average radial inclination, radial length and volar or dorsal tilt were 13.5 degrees, 6.3 mm and 23.5 degrees respectively. An open wedge radial osteotomy followed by interposition of trapezoidal iliac crest bone graft and fixation with plate ands crews was performed in all patients four months at least after the initial surgery. An ulnar leveling procedure was considered necessary in 2 patients. Results: All patients were available in the last follow up evaluation (mean 3.7 years). The functional result according to Mayo wrist score was rated as very good in 15 patients, good in 7 and poor in 6. The average improvement in radial inclination was 14 degrees, in radial length 6.5 mm and in volar or dorsal tilt 21 degrees. The complication rate was 22.7%, including 2 material failures, 1 extensor pollicis longus rupture, 1 nonunion and 3 recurrences of the deformity. Conclusion: Surgical reconstruction for malunion is technically demanding and may not completely restore the anatomy. Patient satisfaction, however, in terms of increased function, decreased pain and decreased deformity is sufficient high to warrant reconstructive treatment

Aim: To demonstrate that external þxation cannot be used alone to treat unstable distal radial fractures associated with a combination of dorsal and volar comminution. Methods: 17 patients with a mean age of 47.5 years, sustaining Frykman grades VII and VIII fractures of the distal radius associated with high energy trauma between 1996 and 1998, treated solely with external þxation were assessed. The mean time to operation was 3.4 days. The mean time to review was 15.8 months. There was dorsal comminution in 7 patients with additional volar comminution in 10 cases. Results: Excellent functional outcome results were obtained with a mean mass grip strength of 79.6%. However, when comparing patients with a combination of dorsal and volar comminution with those sustaining dorsal comminution alone, loss of radiographic parameters resulted in the former at review. Post-operative and review mean volar tilt values were + 1.5¡ and Ð 3.6¡ respectively cf. + 2.3¡ and 6.6¡, whilst the mean post-operative and review radial length values were 13.9 mm and 10.7 mm respectively cf. 11.6 mm and 11.4 mm. Comparison of the two groups for volar tilt and radial length gave P values of 0.004 and 0.02. Conclusion: External þxation is not an effective sole modality of treatment in cases associated with both dorsal and volar comminution. It is also highly recommended that when considering the use of external þxation, the degree and type of comminution is appreciated on the pre-operative radiographs

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

Aim: To demonstrate that a novel tricalcium phosphate bone cement (Biobon) could be effectively used to þll the dorsal metaphyseal defect after unstable distal radial fractures in the osteopenic wrist, and to conþrm with biomechanical studies that its mechanical properties were incompatible with its sole use. Methods: Compression and Biaxial ßexure testing was performed under both dry and wet conditions of physiological Saline and Ringers Lactate solutions at 37ûC. 9 female patients with a mean age of 65 years sustaining Frykman grade VIII fractures of the distal radius between 1999 and 2000 underwent open reduction and internal þxation with supplementation of the dorsal metaphyseal defect with Biobon. Results: Youngs Modulus (E) and the Ultimate compressive strength (UCS) for the two solutions were identical at 10 hours (406 MPa and 3.24 MPa respectively), reaching a maximum for Ringers Lactate solution. The Biaxial ßexure stress also reached a maximum value at 10 hours for Saline at 37û C (3.96 MPa). A signiþcant improvement of radiographic parameters were observed post-operatively (Mean volar tilt = + 1.1û; Mean radial length = 10.4mm: Mean radial inclination = 20.5û) and remained so at the time of assessment (Mean volar tilt = +2.5û; Mean radial length = 10.4 mm; Mean radial inclination = 21.8û).Conclusion: The use of a tri-calcium phosphate bone cement is an effective means of addressing the dorsal comminution sustained after unstable distal radial fractures. Its biomechanical properties precludes its sole use for the treatment of distal radial fractures

Aims: The purpose the study was to evaluate the radiographic progression of distal radial fractures treated with casting with or without percutaneous wires over a one-year period. Methods: One hundred consecutive patients with unilateral Collesñ fractures were enrolled (78 females, 22 males; mean age 72). These were treated with either a below elbow cast with or without manipulation, or by percutaneous wire þxation and a cast after adequate reduction. Two independent observers evaluated all the patients with serial X-rays at 1, 2, 6 weeks and 1 year. Radial length, shift and inclination and volar tilt were compared to the position immediately after injury. Results: Sixty seven patients showed loss of position beyond that seen at 6 weeks after injury. Only 15% of the 21 patients who did not require a manipulative reduction showed any progression of deformity. Only 19% of the 79 patients that had manipulation (± wire þxation) maintained this throughout. The rest showed either early (6 weeks) or late loss of position with a signiþcant proportion of these showing more than 2mm loss of radial length. Loss of position was more frequent in fractures that were only manipulated compared those manipulated and wired; the latter also tended to lose position late rather than early. Twelve of the 30 cases with early loss of position were re-manipulated but þnal position was almost uniformly equivalent to slip position. Conclusions: Radiological parameters are of prognostic importance. Our standard protocols do not hold fracture reduction at 1 year, with þnal deformity greater than appreciated. No beneþt of remanipulation was observed. There may be a need to modify traditional treatment to hold fractures for longer and be able to resist deforming forces

We compared the radiographs, clinical outcomes, and complications of two techniques used for treatment of unstable distal radius fractures in young adults. Fifty patients were randomized to percutaneous pinning or augmented external fixation. At one year follow-up, the external fixator did not improve the parameters of radial length, radial angulation or volar tilt. Reduction of intra-articular steps was slightly improved. No differences in DASH scores or functional outcomes were observed, but more complications were noted with the fixator. While articular restoration can be slightly improved with use of the external fixator, a higher incidence of complications and patient dissatisfaction was noted. Two common techniques for treatment of unstable distal radius fractures in young adults include percutaneous pinning combined with plaster cast, and application of an external fixator, frequently with adjunctive pinning. The objective of this study was to:. 1. To compare the short and mid-term radiographic and clinical outcomes of these two common fixation techniques. 2. To compare the complications of the two techniques. Fifty patients (< 65 yrs) with unstable fractures of the distal radius were recruited. Patients were randomized pre-operatively to percutaneous pinning or external fixation. All surgery was performed by one of three surgeons. Patients were followed for one year with radiographs and an independent clinical exam including DASH questionnaires. 86% of fractures were AO classification C2 or C3, with an equal distribution of all types in both treatment groups. Use of an external fixator did not improve the parameters of radial length, radial angulation or volar tilt. However, reduction of intra-articular steps was slightly improved with its’ use. No differences in mean DASH scores, total ROM or grip strength were observed. More pin complications were noted with the fixator, and all three patients diagnosed with RSD received external fixation. While external fixation represents a popular first line treatment for unstable distal radius fractures, this study suggests that similar gross radiographic and clinical results can be obtained with percutaneous pinning. While articular restoration can be slightly improved with use of the external fixator in highly comminuted fractures, this must be balanced by a higher incidence of complications and patient dissatisfaction. Funding: Stryker-Howmedica-Osteonics

Aim. Segmental bone defects following osteomyelitis in pediatric age group may require specifically designed surgical options. Clinical and radiographic elements dictate the option. Different elements play a role on the surgeon's choice. Among them, the size of the defect, the size and the quality of the bone stock available, the status of the skin envelope, the involvement of the adjacent joint. When conditions occur, vascularized fibula flap may represent a solution in managing defects of the long bones even during the early years of life. Method. A retrospective study, covering the period between October 2013 and September 2015, was done. Fourteen patients, nine males, five females, aged 2–13 years, with mean skeletal defect of 8.6 cm (range, 5 to 14 cm), were treated; the mean graft length was of 8.3 cm. The bones involved were femur (4), radius (4), tibia (3) and humerus (3). In 5 cases fibula with its epiphysis was used, in 5 cases the flap was osteocutaneous and in the remaining 4 cases only fibula shaft was utilized. After an average time of 8 months from eradication of infection, the procedure was carried out and the flap was stabilized with external fixators, Kirschner's wires or mini-plate. No graft augmentation was used. Results. Total limb reconstruction was achieved in 13 of 14 cases. The average integration period was 3.5 months. The mean follow-up period was 20.7 months (range 22–43). Mean time for full weight bearing in reconstructed lower limb was 5.8 months. All patients were walking pain-free and none with a supportive device. The fibular flap with epiphysis had good functional outcomes. A few early and delayed complications were observed. Lengthening through one graft on the forearm was achieved and the radial length restored. Conclusions. In low resource setting, provided that the technical skills and the right equipment are available, reconstruction of segmental bone defects secondary to hematogenous osteomyelitis in children using vascularized fibula flap is a viable option that salvages and restores limb function

We performed a prospective, randomised study on 57 patients older than 60 years of age with unstable, extra-articular fractures of the distal radius to compare the outcome of immobilisation in a cast alone with that using supplementary, percutaneous pinning. Patients treated by percutaneous wires had a statistically significant improvement in dorsal angulation (mean 7°), radial length (mean 3 mm) and radial inclination (mean 3 mm) at one year. However, there was no significant difference in functional outcome in terms of pain, range of movement, grip strength, activities of daily living and the SF-36 score except for an improved range of movement in ulnar deviation in the percutaneous wire group. One patient developed a pin-track infection which required removal of the wires at two weeks. We conclude that percutaneous pinning of unstable, extra-articular fractures of the distal radius provides only a marginal improvement in the radiological parameters compared with immobilisation in a cast alone. This does not correlate with an improved functional outcome in a low-demand, elderly population

Distal radial volar locking plating systems (DRVLP) are increasingly used for complex fractures of the distal radius. There have been limited studies on volar locking plating systems focusing on functional outcome and complications data. The aim of this study is to assess whether the surgeon can predict which fractures will have a good or poor outcome in terms of clinical, radiological and functional outcome assessment. Patients who sustained a distal radial fracture managed with a radial volar locking plate were identified from hospital audit data systems. Data was collected on all patients from patient notes including radiographs performed pre- and post-operatively and functional scores using the Patient Rated Wrist Evaluation score (PRWE). The study was approved by the Barwon Health Research and Ethics Advisory Committee. In total, there were 153 patients (105 female, 48 male) from all 11 surgeons in the unit. Patients ranged in age from 17 to 91 years, average age of 53.7 years at time of injury (IQR 41-70yr). A quarter had concomitant other injuries, and 60% had type C1-C3 fractures. Most of the patients (n = 147) had the AO Synthes DRVLP, six patients had other volar locking plate systems. Twenty-seven percent of patients (n = 42) had exogenous bone graft insertion for more unstable fracture patterns. The major complication rate was 12% (18/153) with 17 cases requiring further surgery. Post-operative radiographs demonstrated no increase in ulnar variance (median 0.0mm IQR 2.0 to1.0 mm) but an increase in radial inclination by 5 deg (IQR 0-12 deg), radial length by 3.5 mm (IQR 1.0-6.3 mm) and radial tilt by 17 deg (IQR 3-32 deg) (volar angulation) compared to pre-operative radiographs, which was statistically significant (all p<0.001). Ninety percent of patients returned a PRWE form with an average follow-up of 1.16 years (IQR 0.46-2.16yr). Median score for those aged less than 50 years was 14.00 (IQR 6.00-41.50) and did not differ from those greater than 50 years (median 16.00 IQR 4.50-36.00) (p = 1.00). PRWE score across groups categorised by classification of fracture showed large variance within each category and were not significantly different: Class A median 8.00 (IQR 3.50-26.25), Class B 13.00 (IQR 6.75-34.00) and Class C 17 (IQR 5.00-38.50) (p = 0.65). The majority of patients were female and had a type C fracture. Post-operative x-rays displayed an increase in radial inclination, length and tilt, and restoration of radial antatomy. PRWE scores were not different across age groups or classification of the fracture. This demonstrates that predictable outcomes can be achieved with volar locking plates despite fracture complexity if attention is paid to anatomical restoration of the radius, and in more unstable patterns with void support using injectable graft. 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

Fractures of the distal end of the radius should be treated on the same principles as other fractures involving joints. Displaced articular fractures require open reduction to allow anatomical reconstruction of both the radiocarpal and the radio-ulnar joints. For extra-articular fractures with severe comminution and shortening this enables the radial length to be re-established achieving radio-ulnar congruency. Stable internal fixation can be achieved with two 2.0 AO titanium plates placed on each of the ‘lateral’ and the ‘intermediate’ columns of the wrist at an angle of 50° to 70°. This gives good stability despite the tiny dimensions of the plates, and allows early function. We report a series of 20 fractures treated by this method of internal fixation with satisfactory results in all

A computer-assisted method of preoperative planning was used to create virtual models of the deformed distal end of the radius after malunion of a fracture. By comparison with a similar model of the uninjured wrist, values were calculated for the angles and lengths to be corrected by osteotomy. Shifts of the distal fragment were analysed for 33 deformed wrists, 27 of which underwent corrective osteotomy and bone grafting. In more than half the cases there was dorsal or volar shift of 3 mm or more. The accuracy of the correction was measured by comparing the three-dimensional models before and after osteotomy with the model of the normal wrist. The volar and ulnar inclination angles of the articular surface of the radius and the radial length were regularly restored to normal

Purpose of the study: The outcomes of different stabilization methods for unstable forearm fractures are described. Material and methods: From January 1980 through December 2000, 29 patients were treated at the central military hospital orthopedics uint for proximal forearm fractures, 27 underwent surgery. We used the Beaufils classification, depending on the localization of the ulnar fracture. Type 1: metaphyseal fracture (n=12) with dislocation of the radial cup; type 2: epiphyseal fracture with transolecraneal dislocation (n=6); type 3: metaphyso-epiphyseal fracture with anterior dislocation (n=5); type 4: metaphyso-epiphyseal fracture with posterior dislocation (n=5). Results: Outcome was assessed at six months to 20 years follow-up. According to the Morrey classification, outcome was excellent for six patients, good for nine, fair for seven and poor for three. Six patients had a stiff joint, one had a synostosis and three nonunion. Conclusion: To achieve satisfactory outcome, it is crucial to achieve internal fixation of the proximal ulna and reconstruction of the radial length. Resection without replacement of the radial cup is contraindicated in these associated fractures

53 patients underwent closed reduction and longitudinal k-wiring of displaced Colles’ fractures and were reviewed after a mean of 26 months. Radiographs taken at the time of injury, after reduction and k-wiring, and at fracture union were compared for radial shortening and dorsal angulation. Manipulation significantly improved fracture position (p< 0.001). Dorsal angulation was successfully corrected by manipulation in 98%, and this position was maintained to fracture union in all cases. 73% of fractures manipulated for radial shortening > 2mm were adequately reduced, but 41% of these fractures subsequently lost position to malunite. The mean shortening between reduction and fracture union was 1.6mm. This did not correlate with Frykman Class or radial shortening at injury. Closed Reduction and k-wire stabilisation is an attractive technique because it is relatively non-invasive compared with plating or external fixation. However, a degree of radial shortening between reduction and fracture union must be anticipated. Fractures reduced inadequately to allow for this loss of radial length, are more likely to malunite. This may compromise functional outcome