Robert Jones bandage versus cast in the treatment of distal radius fracture in children: A randomized controlled trial / 中华创伤杂志(英文版)

PURPOSE@#The present study aimed to treat fractures of the distal end of the radius in children with Robert Jones (RJ) bandage. The objective was to compare this treatment modality with the cast regarding the frequency of the complication occurrence, child comfortability, and family satisfaction.@*METHODS@#The study was a randomized controlled non-inferiority clinical trial including children with recent (less than 5 days) fractures at the distal end of the radius OTA/AO 23-A2, which is usually treated conservatively. Those with open fractures, pathological fracture, severely displaced fracture that needs reduction or multiple injuries were excluded. The participants were divided randomly into 2 groups according to the treatment modalities. Group 1 was treated by plaster of Paris cast (the control group), and Group 2 by modified RJ bandage (the trial group). The difference between the 2 groups was found by the Chi-squared test. The difference was considered statistically significant when the p value was less than 0.05.@*RESULTS@#There were 150 children (aged 2 - 12 years, any gender) included in the study, 75 in each group. The complications occured in 5 (3.3%) cases only, pressure sores of 3 cases in Group 1 and fracture displacement of 2 cases in Group 2. There was no statistically significant difference in the rate of complication occurrence between both modalities of treatment (p = 0.649). Children treated by RJ bandages were more comfortable than those treated by the cast (97.3% vs. 73.3%, p < 0.001) with a statistically significant difference between them. Contrary to that, the families were more satisfied with the cast than RJ bandage (88.0% vs. 81.3%), but without a statistically significant difference (p = 0.257).@*CONCLUSION@#RJ bandage is a non-inferior alternative to the cast for the treatment of fractures at the distal end of the radius that can be treated conservatively in children.

Resultados del tratamiento funcional de las fracturas del metatarso en las fracturas del primer radio / Results of Functional Treatment of Metatarsal Fractures in First Radius Fractures

Introducción: Las fracturas del metatarso son las lesiones traumáticas más comunes del pie, y las del primer metatarsiano son las cuartas en frecuencia. El tratamiento funcional de las fracturas metatarsianas consiste en el apoyo efectivo y precoz, sin inmovilización del miembro. Objetivo: Comparar la efectividad del tratamiento funcional en las fracturas del primer metatarsiano con los tratamientos convencionales Métodos: Se realizó un estudio analítico, observacional, retrospectivo, de casos y controles, en 102 fracturas del primer metatarsiano durante un período de ocho años. La muestra incluyó a pacientes de ambos sexos, entre 16 y 65 años de edad. Se comparó el tratamiento funcional con los tratamientos ortopédico y quirúrgico. Las fracturas fueron clasificadas según su localización, recomendación terapéutica y tratamiento efectuado. Los resultados fueron evaluados en función de la duración de la incapacidad temporal y las complicaciones. Resultados: 48 fracturas fueron tratadas con el método funcional y 41 mediante descarga e inmovilización. Los 13 pacientes con criterio de indicación quirúrgica fueron intervenidos mediante reducción y osteosíntesis. Se obtuvo una menor duración de la incapacidad y menos complicaciones con el tratamiento funcional que con los tratamientos convencionales. Conclusiones: En los últimos años ha aumentado la tendencia a tratar las fracturas metatarsianas de manera conservadora y muchos autores recomiendan el método funcional como tratamiento de elección. Este proporciona una curación más temprana y ocasiona menos complicaciones que los tratamientos convencionales(AU)

Introduction: Metatarsal fractures are the most common traumatic injuries of the foot, and those of the first metatarsal are the fourth in frequency. The functional treatment of metatarsal fractures consists of effective and early support, without limb immobilization. Objective: To compare the effectiveness of functional treatment in fractures of the first metatarsal with conventional treatments. Methods: An analytical, observational, retrospective, case-control study was conducted on 102 first metatarsal fractures over a period of eight years. The sample included patients of both sexes, between 16 and 65 years of age. Functional treatment was compared with orthopedic and surgical treatments. The fractures were classified according to location, therapeutic recommendation and treatment. The results were evaluated according to the duration of the temporary incapacity and the complications. Results: Forty eight fractures were treated with the functional method and 41 by offloading and immobilization. The thirteen patients with surgical indication criteria were operated by reduction and osteosynthesis. A shorter duration of disability and fewer complications were achieved with functional treatment than with conventional treatments. Conclusions: In recent years, the tendency to treat metatarsal fractures conservatively has increased and many authors recommend the functional method as the treatment of choice. This provides earlier healing and causes fewer complications than conventional treatments(AU)

Three-dimensional analysis of the gap space under forearm casts / 中华创伤杂志(英文版)

PURPOSE@#Secondary displacement represents a frequent complication of conservative treatment of fractures, particularly of the distal radius. The gap space between skin and cast may lead to a certain degree movements and this increased mobility might favor redisplacement. The aim of this study was to develop a new 3D method, to measure the gap space in all 3 geometrical planes, and to validate this new technique in a clinical setting of distal radius fractures.@*METHODS@#This study applies 3D imaging to measure the space between plaster and skin as a potential factor of secondary displacement and therefore the failure of conservative treatment. We developed and validated a new methodology to analyze and compare different forearm casts made of plaster of Paris and fiberglass. An unpaired t-test was performed to document differences between the investigated parameters between plaster of Paris and fiberglass casts. The significance level was set at p < 0.05.@*RESULTS@#In a series of 15 cases, we found the width of the gap space to average 4 mm, being slightly inferior on the radial side. Comparing the two different casting materials, plaster of Paris and fiberglass, we found a significantly larger variance of space under casts made of the first material (p=0.39). A roughness analysis showed also a markedly significantly higher irregularity of the undersurface of plaster of Paris as compared with fiberglass.@*CONCLUSION@#This study allows for a better understanding of the nature of the "gap space" between cast and skin and will contribute to develop and improve new immobilization techniques and materials.

Closed folding apex manipulation combined with splinting for the treatment of double fractures of distal ulna and radius in children / 中国骨伤

OBJECTIVE@#To investigate specific technique and clinical effects of closed folding top consolidation maneuver combined with splint fixation maneuver for consolidation and cedar bark external fixation splint for the treatment of double fractures of distal ulna and radius in children.@*METHODS@#From January 2017 to December 2019, 17 children with double fractures of distal ulna and radius were treated with closed folded apex consolidation maneuver, including 13 males and 4 females, aged from 4 to 11 years old with an average of (7.29±2.34) years old. The fractures were fixed with cedar bark splint and followed up for 6 months, and alignment of fracture was evaluated according to the latest X-rays by follow up, and function of the affected limbs was evaluated by Anderson forearm function evaluation criteria.@*RESULTS@#Fifteen of 17 children were successfully reset immediately, and 2 children were successfully reset again. The average fixed time was (25.00±3.35) days. At 6 months of follow up, 12 patients got excellent results, 3 good, 2 fair, and 0 poor according to Anderson forearm function evaluation criteria. The position of all children were larger than 3/4, and 10 children were received anatomical reduction, alignment of 4 children was less than 10°, 3 children was less than 15°. No complications such as fracture displacement, nonunion, compartment syndrome, and forearm rotation dysfunction occurred.@*CONCLUSION@#Restoration of distal radius double fracture in children with the combination of the closed folding and top fixation maneuver and splint fixation maneuver has advantages of higher success rate, lower complications, which could reduce operating difficultyand pain of patients.

Fractura metafisaria de radio distal asociada a una fractura de escafoides, en un adolescente de 14 años / Distal radius fracture combined with scaphoid fracture, in a 14-year-old teenager / Fratura metafisária do rádio distal associada a uma fratura escafóide em adolescente de 14 anos

La asociación entre fractura de radio distal y fractura de escafoides es una asociación infrecuente, en la presentación inicial, pasa inadvertida muchas veces la fractura a nivel de escafoides. El diagnóstico precoz nos permite un correcto tratamiento evitando posibles complicaciones en la evolución. Se presenta el caso de un adolescente de 14 años con dicha asociación lesional. Se le realizó reducción cerrada y fijación percutánea con alambres de Kirschner a nivel del radio distal y se trató la fractura de escafoides, de forma ortopédica, con yeso antebraquipalmar con inclusión del primer dedo. Se obtuvo la consolidación de ambos focos con excelentes resultados clínicos.

The association between distal radius fracture and scaphoid fracture is a rare association, in many cases the scaphoid fracture can be overlooked at the initial presentation. The early diagnosis allows a correct treatment avoiding possible complications in the follow-up. The case of a 14-year-old teenager with this association is presented. Closed reduction and percutaneous fixation was performed with Kirschner Wires at distal radius fracture, the scaphoid fracture was treated orthopedically with short-arm thumb spica cast. Consolidation of both fractures was obtained with excellent clinical results.

A associação entre fratura do rádio distal e fratura do escafoide é uma associação pouco freqüente; na apresentação inicial, a fratura do escafóide geralmente passa despercebida. O diagnóstico precoce nos permite um tratamento correto, evitando possíveis complicações na evolução. É apresentado o caso de um adolescente de 14 anos com essa associação lesional. Ele foi submetido a redução fechada e fixação percutânea com fios de Kirschner no raio distal, e a fratura do escafóide foi tratada ortopedicamente com um molde de antebraço incluindo o primeiro dedo. A consolidação de ambos os focos foi obtida com excelentes resultados clínicos.

Tratamiento conservador versus tratamiento quirúrgico de fracturas de estiloides cubital en el contexto de fracturas del radio distal / Conservative vs. surgical management of ulnar styloid fractures associated with distal radius fractures

Objetivo: Determinar si los resultados clínicos y radiográficos difieren después del tratamiento conservador y el tratamiento quirúrgico para las fracturas de la estiloides cubital asociadas a fracturas inestables del radio distal tratadas mediante placa volar bloqueada. Materiales y Métodos: Estudio multicéntrico, retrospectivo y descriptivo que incluye pacientes operados en cuatro instituciones, entre 2009 y 2012. Todos tenían fracturas de la estiloides cubital en el contexto de una fractura del radio distal. Las fracturas de la estiloides cubital fueron tratadas de forma conservadora (grupo I) o con cirugía (grupo II). Resultados: El seguimiento promedio fue de 56 meses. Se evaluó a 57 pacientes; grupo I (29 casos) y grupo II (28 casos). Los pacientes del grupo II tuvieron 2,76 veces (IC95% 1,086; 8,80) más posibilidades de lograr una consolidación que aquellos del grupo I. El puntaje DASH y el dolor, tanto en reposo como en actividad, no presentaron diferencias significativas (p = 0,276 y p = 0,877). La desviación cubital y la fuerza obtuvieron mejores resultados en el grupo I (p = 0,0194 y p = 0,024). Conclusiones: Aunque los pacientes con estabilización quirúrgica de la estiloides cubital tuvieron 2,76 más posibilidades de lograr la consolidación que aquellos del grupo I, no hubo diferencias significativas en la evaluación subjetiva (DASH y dolor) entre ambos grupos. Tampoco hubo diferencias significativas cuando se consideró el grado de compromiso de la estiloides cubital, pero la fuerza y la desviación cubital presentaron mejores resultados en el grupo sin fijación de la estiloides cubital. Nivel de Evidencia: III

Objectives: To evaluate potential differences in clinical and radiological outcomes after surgical versus conservative management of ulnar styloid fractures associated with unstable distal radius fractures treated by locked volar plating. Materials and Methods: This was a multicenter, retrospective and descriptive study including surgical patients treated at four different institutions between 2009 and 2012 for ulnar styloid fractures associated with unstable distal radius fractures. Ulnar styloid fractures were treated conservatively in group I and surgically in group II. Results: The average follow-up was 56 months. The study included 57 patients divided into two groups (group I [29 cases] and group II [28 cases]). Patients in group II had 2.76 times (95% CI: 1.086; 8.80) more chances of achieving bone union than those in group I. DASH and pain scores, both at rest and during activity, did not show significant differences between the two groups (p = 0.276 and p = 0.877). Group I presented milder ulnar deviation and better strength (p = 0.0194 and p = 0.024). Conclusions: Although patients who underwent surgery for ulnar styloid fractures had 2.76 more chances of achieving bone union than those who received conservative management, there were no significant differences between both groups in subjective evaluations (DASH and pain scores) or when considering the degree of ulnar styloid involvement. However, the parameters of strength and ulnar deviation were better in the conservative management group. Level of Evidence: III

Fractura de la extremidad distal del radio en un paciente con osteoporosis y déficit de vitamina D / Distal radius fracture in a patient with osteoporosis and vitamin D deficiency

Las fracturas de la extremidad distal del radio tienen una elevada incidencia, y representan una gran parte de las fracturas atendidas en una consulta de traumatología general. En España, se sitúan como la segunda más frecuente tras la fractura vertebral, tienen una mayor prevalencia en el sexo femenino. Varios autores les reconocen un carácter predictivo de nuevas fracturas osteoporóticas; además, el déficit de vitamina D puede estar asociado a un retraso en la consolidación de estas fracturas. Tras el análisis de los datos obtenidos de la revisión de este caso podríamos concluir en que, ante una fractura por fragilidad de la extremidad distal del radio en un paciente joven, debemos descartar no solo la presencia de osteoporosis, sino también de deficiencia de vitamina D asociada. Es importante, por tanto, la repleción de los niveles adecuados de vitamina D que, si bien no acelera el proceso de consolidación, lo garantiza, y ayuda a prevenir nuevas fracturas osteoporóticas, mejora la función neuromuscular y la prevención de caídas. El tratamiento con PTH 1-34 en este tipo de fracturas si está indicado por la enfermedad de base, puede acelerar el proceso de reparación de la fractura de radio. Nivel de Evidencia: IV.

Distal radius fractures have a high incidence, representing a large part of fractures treated in a general trauma consultation. In Spain, they are the second most frequent vertebral fracture, with a higher prevalence in females. According to several authors, they are considered a predictive factor of new osteoporotic fractures, and vitamin D deficiency may also be associated with a delay in the consolidation of these fractures. After analyzing the data obtained from the review of this case, we could conclude that, when treating a young patient with a fragility fracture of the distal radius, we should not only rule out the presence of osteoporosis, but also the associated vitamin D deficiency. It is important, therefore, to replenish adequate levels of vitamin D, which, while not accelerating the consolidation process, guarantees it, helping to prevent new osteoporotic fractures, improving neuromuscular function and preventing falls. Treatment with PTH 1-34 in this type of fracture if indicated by the underlying disease may accelerate the repair process of the radius fracture. Level of Evidence: IV.

Ultrasound treatment for accelerating fracture healing of the distal radius. A control study

PURPOSE: To investigate the accelerating effects of low-intensity pulse ultrasound stimulation (LIPUS) on the fracture healing of distal radius. METHODS: A total of 81 patients with distal radius fracture were randomly divided into two groups: the ultrasound treatment group and the control group. Patients in the ultrasound treatment group were immobilized in a below-elbow cast and received LIPUS treatment 15 min/day, while the control group were immobilized by a plaster support and cast. The patients were followed up every week and took X-ray films. The initial and healed X-ray films and the gray value of fracture site were analyzed by Photoshop software. The effect of reposition was evaluated based upon Steward recommended by Dienst, combining with Aro's measuring method. RESULTS: Clinical fracture healing time in ultrasound group was significantly shorter than that in the control group (32.04 ± 2.58d vs. 40.75 ± 5.12d, p <0.01). In addition, the grey value changes of fracture sites of the ultrasound group were much higher than that of the control group. The reposition effects of fracture healing had no difference between the two groups (p >0.05). CONCLUSION: Low-intensity pulse ultrasound stimulation could accelerate fracture healing of the distal radius and promote local bone formation. .

Efeito do Symphytum officinale na consolidação de fraturas de rádio e ulna de ratos / Symphytum officinale effect on the consolidation of radio and ulna fractures in rats

Introdução: o estudo da consolidação óssea e dos diversos fatores capazes de estimular o processo de reparo ósseo envolve muitas pesquisas na literatura. Objetivo: testar o efeito do Symphytum officinale na consolidação de fraturas de rádio e ulna em ratos. Método: os autores avaliaram 34 ratos da linhagem Wistar, nos quais foi realizada fratura manual dos ossos do antebraço direito sob anestesia. Os ratos foram divididos aleatoriamente em dois grupos. O grupo experimento recebeu duas gotas da substância Symphytum officinale e o grupo controle recebeu duas gotas de soro fisiológico 0,9%, administradas em ambos na frequência de três vezes ao dia pelo método da gavagem. Após o sacrifício, aos 14 e 28 dias de tratamento, foi realizada dissecção dos rádios e das ulnas. Os ossos foram radiografados e submetidos à leitura da densitometria óptica radiográfica. Resultados: foram observadas diferenças na formação do calo ósseo ulnar em relação ao radial, independentemente do grupo estudado na comparação entre o grupo controle e experimento. Conclusões: a formação do calo ósseo ulnar apresentou maior densidade óssea em relação ao calo radial, independentemente do grupo estudado, e a substância Symphytum officinale, em doses homeopáticas, não se mostrou estimulante da consolidação de fraturas em antebraços de ratos da raça Wistar.

Introduction: there are several studies in medical literature covering the subject of bones consolidation, as well as the several stimulating factors related to it. Objective: to test the effect of Symphytum officinale in bone consolidation of radio and ulna fractures in rats. Method: the authors describe a survey conducted over a sample of 34 rats of Wistar lineage, randomly divided in two different groups, on which a manual procedure to cause the fractures in the bones of the right forearm was conducted with anesthesia. The rats of the experimental group were given two drops of a substance known as Symphytum officinale and the rats of the control group were given two drops of physiologic saline, 0.9%. For those two groups, the drugs were given three times per day by gavage. After the sacrifice of the rats, a series of dissections of the radio and the ulna bones was conducted. All bones were submitted to X-rays and to optical densitometry radiographic devices. Results: a difference in the bone callus formation of ulna was observed when compared to the bone callus formation of radio, regardless of the groups. Conclusions: the bone callus formation of the ulna presented more bone density in relation to radio callus, independently to the studied group and Symphytum officinale, in homeopathic doses, did not stimulate the bone fractures consolidation in forearms of Wistar rats lineage.

Manejo terapéutico de pacientes con fractura del extremo distal de radio mayores de 60 años: revisión sistemática / Treatment of distal radius fractures in patients over 60 years old: a systematic review

The distal radius fracture is a fairly common clinical problem in elderly patients, treatment can be either surgical or conservative. We present a synthesis of evidence relating to compare the functional improvement of both treatment modalities, through a Systematic Review of randomized Clinical Trials. Objective: To determine whether there is scientific to endorse that functional improvement in the medium and long-term conservative versus surgical management in patients with fracture of the distal radius over 60 years. Search Strategy: Were included in Search Randomized Clinical Trials (RCTs), meta analysis (MT) and systematic Reviews (RS), the databases used were Medline, CINALH, Central (Cochrane), Lilacs and PEDro. Results: We selected three RCTs that met the eligibility criteria. Conclusions: There is limited evidence that surgical methods studied did not have better functional outcomes and long-term, compares with a closed reduction and cast. The SF-36 at 3-4 months, gives a DM of 3.01 (-1.6- 7.62), difference is not statistically significant (p = 0.54).

La fractura de radio distal es un problema clínico bastante frecuente en adultos mayores, el tratamiento puede ser de tipo quirúrgico o conservador. Realizaremos una síntesis de la evidencia, relativa a comparar la mejoría funcional de ambas modalidades terapéuticas, a través de una revisión sistemática de Ensayos Clínicos Aleatorizados. Objetivo: Determinar si existe evidencia científica que avale la mejoría funcional a mediano y largo plazo del manejo quirúrgico versus el conservador en pacientes con fractura del extremo distal del radio mayores de 60 años. Estrategia de Búsqueda: Se incluyeron en la búsqueda Ensayos Clínicos Aleatorizados (ECAs), Metaanálisis (MT) y Revisiones Sistemáticas (RS), las Bases de datos usadas fueron: Medline, CINALH, Central (Cochrane), Lilacs y PEDro. Resultados: Se seleccionaron 3 ECAs que cumplían con los criterios de elegibilidad. Conclusiones: Existe limitada evidencia que los métodos quirúrgicos estudiados no presentan mejores resultados funcionales a mediano y largo plazo, comparados con una reducción cerrada más yeso. El SF-36 al 3-4 mes, da una DM de 3,01 (-1,6 - 7,62), diferencia que no es estadísticamente significativa(p = 0,54).

Tratamiento quirúrgico con clavo intramedular elástico estable en fracturas diafisiarias del antebrazo en niños / Treatment of forearm shaft fractures in children by elastic stable intramedullary nail

Objetivo: Evaluar los resultados del tratamiento quirúrgico de las fracturas diafisiarias del radio y/o cubito mediante la colocación intramedular de clavos Kirschner moldeados en pacientes pediátricos. Material y métodos: Estudio descriptivo observacional de pacientes tratados con clavo intramedular en fracturas diafisiarias de antebrazo en elHospital Nacional Cayetano Heredia û Lima. Se usaron clavos Kirschner moldeado de acuerdo a especificaciones del clavo ESIN y se evaluaron la técnica operatoria, tiempo de consolidación, complicaciones y funcionalidad. Resultados: Se incluyeron 12 pacientes, 10 de sexo masculino, con edad promedio de 13.7 años (11 a 15 años), se encontró evidencia de consolidación a las seis semanas y el tiempo operatorio promedio fue de 75 minutos. Un paciente presentó parestesias del nervio cubital que remitió a los 4 meses, la perdida sanguínea fue mínima con un abordaje minimamente invasivo. Todas las fracturas consolidaron. Conclusión: El uso de clavo Kirschner moldeado es una alternativa de tratamiento en este tipo de fracturas debido a su bajo costo, y resultados comparables con el ESIN que es el tratamiento de elección.

Objective: To evaluate the surgical treatment of radius or ulna shaft fractures by molded intramedullary Kirschner wire in paediatric patients. Material and methods: Descriptive observational study of patients treated with intramedullary nailing of forearm diaphyeal fractures al the Hospital Nacional Cayetano Heredia. We used Kirschner wires molded acording to ESIN specifications, evaluating the surgical technique, time of consolidation, complications, and functional results. Results: We evaluated 12 patients, 10 male and 2 females, with average age of 13.7 years and evidence of consolidation in six weeks. Operative time averaged 75 minutes. One patient presented ulnar nerve paresthesias that improved in four months, little blood less with a minimally invasive approach, 78 per cent of all fractures healed with good functional outcome. Conclusion: The use of Kirshner molding wires is an alternative treatment in this type of fractures due its low cost and results comparables with the ESIN that is the treatment of choice.

Manejo de las fracturas del tercio distal del radio / Management of fractures of the distal radius

Las fracturas del tercio distal del radio ocupan un gran porcentaje de discapacidad a diario en nuestro país ya que representa más del 12% de los motivos de consulta en la emergencia de la mayoría de los hospitales. Muchos métodos de tratamiento son aceptados con buena evolución clínica pero con gran porcentaje de complicaciones. De ahí la inquietud en buscar el mejor método de tratamiento que ayude al paciente a su incorporación a la vida diaria. Se presenta la experiencia en el tratamiento de 25 pacientes que presentaron fracturas del tercio distal del radio desde enero de 2007 a noviembre de 2008; entre las edades comprendidas de 39 a 74 años distribuyéndose 17 mujeres y 8 hombres. Evaluando el tipo, mecanismo de producción de las fracturas y utilizando la clasificación de Fernández tratadas con placas de sostén y tornillos de cortical 3,5 técnica AO con un abordaje volar.

Reabilitação das fraturas do rádio distal: [revisão] / Rehabilitation of distal radius fractures: [review]

O objetivo deste estudo foi avaliar a evidência do efeito e eleição da conduta terapêutica nas fraturas do rádio distal. A revisão sistemática utilizou as bases de dados PubMed, Lilacs, Pedro, Cochrane, Scielo, OTseeker, sem restrições de período de publicação, com as seguintes palavras chaves: fraturas do rádio, reabilitação, terapia ocupacional, fisioterapia, incluindo línguas inglesa, espanhola, francesa e portuguesa. Os estudos encontrados foram avaliados independentemente pelos dois autores utilizando critérios da escala PEDro. Estudos não experimentais foram incluídos em busca de esclarecimentos sobre a reabilitação. Foram encontrados 22 estudos, sendo 14 ensaios clínicos controlados randomizados (ECRs). Dentre eles, quatro compararam mobilização precoce com tratamento convencional apresentando evidência moderada a favor da primeira; sete confrontaram tratamento baseado em exercícios domiciliares com tratamento em consultório apontando evidência conflitiva (um deles também comprovou eficácia de mobilização acessória passiva); e três analisaram eficácia de procedimentos terapêuticos: campo eletromagnético pulsado, drenagem linfática, ultra-som, indicando evidências limitadas. Os nove estudos não experimentais encontrados não apresentaram informações suficientes sobre os questionamentos desta pesquisa. Observou-se uma tendência dos autores em utilizar os princípios gerais da reabilitação ao elaborar condutas terapêuticas, mas os procedimentos utilizados não estão bem atestados pela literatura.

The aim of this study was to assess the evidence regarding the adoption and effectiveness of therapeutic procedures employed for rehabilitation of distal radius fractures. This systematic review used the following databases: PubMed, Lilacs, PEDro, Cochrane, Scielo and OTseeker, without time restrictions. The following keywords were searched for: distal radius fracture, rehabilitation, occupational therapy, physiotherapy including reports in English, Spanish, French, and Portuguese. Twenty-two studies were retrieved and analyzed by two independent investigators following the PEDro scale criteria. Other non-experimental studies were included for additional information regarding certain rehabilitation approaches. Of the 14 randomized controlled clinical trials, four compared early mobilization to conventional therapy, showing moderate evidence in favor of earlier mobilization. Seven compared home therapy based on orientations to individual conventional therapy and found conflicting evidences. Three studies also analyzed the efficacy of the following specific therapeutic procedures: Pulsating magnetic field, lymphatic drainage, and ultrasound, which showed limited empirical support. The nine non-experimental studies did not add sufficient information regarding these issues. There was a trend to employ general principles of rehabilitation when elaborating these therapeutic approaches, but these procedures were not adequately supported by literature.

Correlación clínico-radiológica funcional del tratamiento de las fracturas distales del radio con osteodesis percutánea / Clinical-radiological correlation of wrist function after distal radius fracture treated with percutaneous pinning

El objetivo del trabajo es evaluar la función residual de la articulación de la muñeca luego de sufrir una fractura distal del radio desplazada, reducción incruenta, osteodesis percutánea y correlacionarlo con las imágenes radiológicas residuales.

[Role of pinna cartilage autograft on long bone healing in dog: radiographic and biomechanical studies]

To evaluate the feasibility of pinna cartilage autograft in healing of long bone defects in dogs. Experimental study. Mid-diaphyseal region of the right radial bone of ten Mongrel dogs of both sexes with average weight of 29 +/- 2.4 kg, which were randomly assigned to either control [n=5] or experimental group [n=5]. Creation of a bone gap at the mid-diaphyseal region of the right radius in each dog followed by cosmetic ear trimming. Insetion of a piece of pinna cartilage within the bone defect in experimental group was done and postoperative lameness scored. Radiographic evaluation in two views every 2 weeks for 70 days was performed. The dogs were euthanized after 70 days and their operated and intact radial bones were subjected to bending test. Repeated measures ANOVA and independent t-test were done for callus index measurements. Results of lameness scores were evaluated using Kruskal-Wallis test. Lameness scores were statistically improved in experimental group by the time, as compared with control group. Callus index was statistically greater in experimental group at 28, 42,56 and 70 days after surgery than the previous days. [P<0.05]. Biomechanical quality [maximum load, elastic modulus, and maximum bending moment] enhanced in the operated bones of experimental group. The results of this study revealed that pinna cartilage in dogs may be used as an available chondrocyte-rich autograft to enhance bone healing process in fractures at risk to enhance bone healing process in fractures at risk of delayed or non-union treatment of both conditions, and in bone defects

Tratamiento quirúrgico en las fracturas del extremo distal del radio en el adulto / Surgical procedure of distal end radius fractures in the adult

Se realizó un estudio observacional, descriptivo y longitudinal, en el Servicio de Ortopedia y Traumatología del Hospital Comunitario de Augustinopolis, Tocantins, Brasil en el periodo Marzo 1998 a Marzo 2002. La muestra estuvo constituida por 59 pacientes adultos, mayores de 20 años con el diagnóstico de fractura del extremo distal del radio, a los cuales se les practicó tratamiento quirúrgico consistente en reducción cerrada y enclavijamiento percutáneo en las fracturas extraarticulares simples y conminutivas y las intraarticulares simples con un alambre de Kirschner de acción elástica o con dos alambres para lograr fijación rígida de los fragmentos. En las fracturas intraarticulares conminutivas, cuando fue posible la reducción estable y anatómica de la superficie articular, se practicó reducción cerrada y enclavijamiento percutáneo con dos alambres e Kirschner; así como reducción abierta y fijación con varios alambres de Kirschner, cuando no fue posible el restablecimiento anatómico de la superficie articular. Se utilizó el método porcentual para el análisis estadístico. Existió predominio en el sexo femenino mayores de 40 años, predominaron las facturas en extensión (84.7 porciento) y las intraarticulares (54.2 porciento), no se reportaron casos con rigidez articular, ni con distrofia simpático refleja; los resultados funcionales de la muñeca tratada fueron buenos.

Tratamento das fraturas instáveis da extremidade distal do rádio pelo método intrafocal de Kapandji modificado / Treatment of unstable distal radius fractures by modified Kapandji's intrafocal method

Objetivo: Demonstrar a eficácia do método de fixação das fraturas extra-articulares redutíveis instáveis fechadas da extremidade distal do rádio em pacientes com boa qualidade óssea, tratados pela técnica de fixação percutânea intrafocal e verificar os resultados anatômicos, radiológicos e funcionais obtidos, bem como as possíveis complicações encontradas. Métodos: Foram analisados, em estudo prospectivo, os resultados obtidos com o tratamento cirúrgico de 29 pacientes com média de idade de 49 anos, sendo o sexo feminino o mais freqüentemente acometido (58,6 por cento dos casos). A fixação cirúrgica foi indicada nas fraturas que apresentavam, na radiografia inicial (ântero-posterior e perfil), angulação dorsal maior que 20 graus, acentuada cominuição dorsal e encurtamento do rádio maior que 10mm. A técnica utilizada foi a de fixação intrafocal, tipo Kapandji, com fios de Kirschner lisos. Resultados: A avaliação funcional, segundo Gartland e Werley, revelou 72,1 por cento de excelentes e bons resultados em três meses, 89,7 por cento aos seis meses e 96,6 por cento aos 12 meses. A redução obtida no pós-operatório imediato sofreu perda pequena, porém progressiva até o seguimento final aos 12 meses. Ocorreram complicações em seis pacientes: quatro apresentaram distrofia simpático-reflexa, um evoluiu com infecção superficial no ponto de entrada do fio de Kirschner e outro apresentou parestesia do ramo superficial do nervo radial. A técnica utilizada mostrou-se efetiva no tratamento das fraturas extra-articulares redutíveis instáveis da extremidade distal do rádio, sendo de fácil aprendizado e execução. O material utilizado é de baixo custo e amplamente disponível em centros cirúrgicos

Epidemiología y manejo de la fractura articular radio distal en el Hospital Militar Central, entre los años 2000 y 2003 / Epidemiology and managing of the fracture to articulate radius distal in the Military Central Hospital, between the year 2000 and 2003

El presente es un trabajo descriptivo, retrospectivo y transversal que evalúa el manejo de las fracturas articulares radio distales realizadas en el Hospital Militar Central entre los años 2000 y 2003. 586 pacientes ingresaron por Emergencia con un diagnóstico de fractura radio distal. Se seleccionaron 196 pacientes que presentaron un total de 203 fracturas articulares, de los cuales, luego de depurar las historias, placas radiográficas y TAC, 148 casos completaron los requisitos de la ficha de recolección de datos siendo ésta la población final de nuestro estudio. La mayor incidencia de fracturas, en gran parte, producidas por mecanismos de alta energía, fueron las fracturas tipo Melone II (54.1 por ciento), seguidas por las del tipo Melone IV (22.3 por ciento) y el restante 20 por ciento en distribución variada entre aquellas del tipo Melone III y Melone I. Del total de casos, un 77 por ciento de las lesiones mostraron fracturas asociadas de estiloides cubital. Se encontró que en el 54.1 por ciento de casos se aplicó la reducción cruenta más alambres de Kirschner como tratamiento para fracturas tipo Melone II (53.4 por ciento) y Melone I (0.7 por ciento); seguido en un 25.0 por ciento en los que se aplicó la reducción cruenta más osteosíntesis con placa y tornillo para fracturas tipo Melone III (14.2 por ciento) y tipo Melone IV (10.8 por ciento). Otras técnicas utilizadas, como la reducción cruenta más fijación externa en neutralización se utilizó en un 8.1 por ciento de casos, con un 6.1 por ciento para el tipo Melone IV y 2.0 por ciento para el tipo Melone III; la reducción incruenta percutánea con alambres de Kirschner en un 6.8 por ciento de casos, con un 6.1 por ciento para el tipo Melone I y un 0.7 por ciento para el Melone II; y la reducción cruenta más fijación externa en ligamentotaxis utilizada en un 6.1 por ciento para el tipo Melone IV (5.4 por ciento) y el tipo Melone III (0.7 por ciento). El injerto óseo se aplicó en 20...

The present is a retrospective transversal work of research that evaluates the treatment of intra-articular distal radius fractures carried out at the Central Military Hospital between the years 2000 y 2003. Out of a total of 586 patients that entered the hospital through the emergency entrance with a diagnosis of distal radio fractures, 196 were selected that presented a total of 203 articular fractures, of which after studying the medical histories and radiographic plates, 148 cases completed the requirements of the chart of recollection of data being this the final population of our study. The greatest incidence is on its majority by mecha- nisms of high energy was that of the fractures Melone Il type (54.1 %), followed by those of Melone IV type (22.3%) and the remaining 20% in a varied distribution between those of Melone III and Melone I types. Of the total of cases studied, 77% of the injuries showed ulnar styloid fractures. It was determined that in 54.1 % of cases, the open reduction + Kirschner wires was applied as a treatment of fractures Melone Il type (53.4%) and Melone I type (0.7%), followed in a 25.0% by those in which was applied the open reduction + plate/screw for fractures Melone III type (14,2%) and Melone IV type (10.8%). The other techniques used, like open reduction + external fixation (Neutralization), closed reduction + percutaneous Kirschner wires and open reduction + external fixation (Ligamentotaxis) were used in a 8.1 %, with a 6.1 % for Melone IV type and 2.0% for Melone type Ill; in a 6.8% with 6.1 % for the type Melone III type and 0.7% for the Melone Il type, and in 6.1% for Melone IV type (5.4%) and the Melone III type (0.7%) respectively. In relation to the use of bone grafting, it took place in a 20% of cases, being the TAC the auxiliary examin a 75.7% of cases. As a conclusion it is established that in general all the...

role of bridging callus in the management of atrophic nonunion of long bones fractures

Twenty four patients with established atrophic nounited fractures of long bone with a gap less than 1 cm treated by application of autogenous cancellous bone graft and bridging device without interference of fibrous union. The femur was involved in 10 cases, the tibia in 6, the humerus in 5 and radius and ulna in 3 cases. The patients were 17 males and 7 females with a mean age of 40 years. At a mean follow up of 13 months, 23 patients got union in an average of 4 months. 12 patients were rated as excellent, 10 patients were rated as good and 2 patients rate as poor result in regard to the functional outcome.This suggest that in the presence of a well vasculaized envelope of muscles the application of outogenous cancellous bone graft in conjunction with bridging device represents a good alternative to a more demanding surgical techniques needed to achieve union