Radiological Evaluation of Volar Cortical Angle in the Anatolian Population / Evaluación Radiológica del Ángulo Cortical Volar en la Población Anatoliana

SUMMARY: Distal radius fractures are the most common fractures of the upper limb. The most commonly used method in the repair of these fractures is volar locking plates. Recently, the frequency of removal of volar locking plates after surgery has increased. There are many factors in its reduction. Anatomically, incompatibility of the distal end of the radius with volar locking plates is one of them. In previous studies, different volar cortical angle (VCA) values were found in other races. For this reason, this study aimed to determine the mean values by making VCA measurements of the Anatolian population. The study was designed retrospectively. In the study, measurements were made on computed tomography (CT) images of the distal end of the radius of 53 men and 28 women. Radial width, intermediate volar angle, and radial volar angle were measured in the images. On average, the radius width was 23.35±1.96 mm, and the intermediate volar angle was 26.02±.3.83°, radial volar angle was 24±3.07°. Radial width, intermediate volar angle, and radial volar angle differed significantly by gender (p<0.001). A significant correlation was found between radius width, intermediate volar angle, and radial volar angle values (p<0.001). It has been determined that the Anatolian population has a different VCA value than the European, Asian, and other populations. When using volar locking plates in distal radius fracture surgery, volar locking plates should be selected by considering the average values of the races.

Las fracturas del radio distal son las fracturas más comunes del miembro superior. El método más utilizado en la reparación de estas fracturas son las placas de bloqueo volar. Recientemente, ha aumentado la frecuencia de extracción de placas de bloqueo volar después de la cirugía. Existen muchos factores en su reducción y anatómicamente, la incompatibilidad de la extremidad distal del radio con las placas de bloqueo volar es una de ellas. En estudios anteriores, se encontraron diferentes valores del ángulo cortical volar (VCA) en otras grupos. Por esta razón, este estudio tuvo como objetivo determinar los valores medios, realizando mediciones de VCA de la población de Anatolia. El estudio fue diseñado de manera retrospectiva. En el estudio, se realizaron mediciones en imágenes de tomografía computarizada (TC) de la extremidad distal del radio de 53 hombres y 28 mujeres. En las imágenes se midieron el ancho radial, el ángulo volar intermedio y el ángulo volar radial. En promedio, el ancho del radio fue de 23,35 ± 1,96 mm, el ángulo volar intermedio fue de 26,02 ± 3,83° y el ángulo volar radial fue de 24 ± 3,07°. El ancho radial, el ángulo volar intermedio y el ángulo volar radial difirieron significativamente según el sexo (p<0,001). Se encontró una correlación significativa entre los valores del ancho del radio, el ángulo volar intermedio y el ángulo volar radial (p<0,001). Se ha determinado que la población de Anatolia tiene un valor de VCA diferente al de las poblaciones europeas, asiáticas y otras. Cuando se utilizan placas de bloqueo volar en cirugía de fractura de la extremidad distal del radio, las placas deben seleccionarse considerando los valores promedio de los individuos de diferentes grupos.

Radiographic morphometry of the distal end radius in Anatolian population / Morfometría radiográfica del extremo distal del radio en la población de Anatolia

SUMMARY: Distal radius fractures are one of the most common orthopedic injuries encountered by orthopedic surgeons. Correction of dorsal tilt and radial height is essential to restore normal biomechanics of the wrist joint. Comprehensive knowledge of the morphometry of the distal radius of the local population becomes critical for the treating surgeon. This study aims to report the morphometry of the distal radius in the Anatolian population and compare it with similar studies in other races and humans. Radiographs of one hundred and twenty-four people were included in the study. Four radiological parameters were examined on all radiographs: radial height, radial tilt, ulnar variance, and palmar tilt. Radial tilt was 23.35°±1.96; palmar tilt was 15.7°±2,87 radial height (mm) was 10.55±4.34, ulnar variance (mm) was 0.32±1.79. The highest rate of negative ulnar variance was found. According to the study's results, reference data varying by race for anatomical fit should be considered in treating DER injuries.

Las fracturas de la parte distal del radio son probablemente las lesiones ortopédicas más comunes que encuentran los cirujanos ortopédicos. La corrección de la inclinación dorsal y la altura radial es esencial para restaurar la biomecánica normal de la articulación de la muñeca. El conocimiento integral de la morfometría del radio distal de la población local es importante para el cirujano tratante. Este estudio tuvo como objetivo reportar la morfometría de la parte rdistal del radio en la población de Anatolia y compararla con estudios similares en otras razas y humanos. Se incluyeron ciento veinticuatro radiografías simples consecutivas de la articulación de la muñeca. Se examinaron cuatro parámetros radiológicos: altura radial, inclinación radial, variación ulnar e inclinación palmar. El ángulo de inclinación radial fue de 23,35±1,96; el ángulo de inclinación palmar fue de 15,7±, la altura radial (mm) fue de 10,55±4,34, la varianza ulnar (mm) fue de 0,32±1,79. Se encontró la tasa más alta de varianza ulnar negativa (43,5%). Los resultados de este estudio deben tenerse en consideración al tratar fracturas de la parte distal del radio, con datos de referencia que varían según la raza para el ajuste anatómico.

Estudio morfométrico del radio proximal en una población chilena / Morphometric study of the proximal radius in a Chilean population

RESUMEN: El objetivo de esta investigación fue determinar la morfometría del extremo proximal del radio, mediante mediciones efectuadas en la cabeza, cuello y tuberosidad del radio, en una población chilena y compararlas según sexo. Se efectuó un estudio transversal analizando exámenes de Tomografía Computarizada (TC) de codo, realizados entre enero de 2014 y diciembre de 2018. Se incluyó 32 TC, correspondientes a 16 hombres y 16 mujeres. Se transfirió las imágenes formateadas al software RadiAnt, para efectuar las mediciones en el radio proximal. El análisis estadístico de los resultados se realizó mediante el software SPSS 22. El diámetro de la cabeza del radio en hombres osciló entre 22,8±1,3 y 25,0±1,7 mm; en mujeres osciló entre 19,4±1,4 y 20,7±1,4 mm. El diámetro del cuello del radio proximal en hombres osciló entre 14,0±0,8 y 15,6±0,7 mm; en mujeres osciló entre 11,7±0,8 y 13,3±1,3 mm. El diámetro del cuello del radio distal en hombres osciló entre 14,4±1,0 y 16,0±1,2 mm; en mujeres osciló entre 12,5±1,0 y 13,8±1,5 mm. El diámetro de la tuberosidad radial en hombres osciló entre 15,1±1,5 y 17,7±1,8 mm; en mujeres osciló entre 13,2±1,1 y 15,5±1,8 mm. El promedio de altura de la cabeza del radio fue de 11,2±1,2 mm en hombres y de 9,5+0,8 mm en mujeres. El análisis comparativo entre sexos mostró diferencias estadísticamente significativas en todas las mediciones precedentes. El promedio de altura del cuello del radio fue de 11,2±1,2 mm en hombres y 10,1±1,6 mm en mujeres, sin diferencia significativa (p= 0,15). Los valores promedios de la morfometría del radio proximal de la población chilena difieren de los descritos para la población europea y presentan algunas similitudes con la población china. Nuestros resultados pueden ser de utilidad para el diseño de implantes y prótesis para el extremo proximal del radio y para una correcta planificación quirúrgica en ortopedia y traumatología.

SUMMARY: The aim of this research was to determine the morphometry of the proximal radius in a Chilean population, by means of measurements made in head of radius, neck of radius and radial tuberosity, and to compare them according to sex. A cross-sectional study was conducted analyzing Computed Tomography scans (CT) of elbows, performed between January 2014 and December 2018. Thirty-two CT corresponding to 16 men and 16 women were included. The formatted images were transferred to the RadiAnt software in order to perform measurements in the proximal radius. The statistical analysis of the results was performed using the SPSS 22 software. The diameter of the head of radius in men ranged between 22.8±1.3 and 25.0±1.7 mm; in women it ranged between 19.4±1.4 and 20.7±1.4 mm. The diameter of the proximal neck of radius in men ranged between 14.0±0.8 and 15.6±0.7 mm; in women, it ranged between 11.7±0.8 and 13.3±1.3 mm. The diameter of the distal neck of radius in men ranged between 14.4±1.0 and 16.0±1.2 mm; in women, it ranged between 12.5±1.0 and 13.8±1.5 mm. The diameter of radial tuberosty in men ranged between 15.1±1.5 and 17.7±1.8 mm; in women, it ranged between 13.2±1.1 and 15.5±1.8 mm. The mean height of the head of radius was 11.2±1.2 mm in men and 9.5±0.8 mm in women. Statistically significant sex differences were revealed in all the preceding measurements. The mean height of the neck of radius was 11.2±1.2 mm in men and 10.1±1.6 mm in women, with no significant difference (p= 0.15). The average values of morphometry of the proximal radius of the Chilean population differ from those describing the European population, and show some similarities with the Chinese population. Our results may be useful to design of implants and prostheses for the proximal radius, and to correct surgical planning in orthopedics and traumatology.

The measurement of dorsal radial tilt by x-ray and computed tomography

SUMMARY OBJECTIVE: We conducted this study to define and measure the dorsal radial tilt, and to guide the reduction of distal radius fractures and the pre-bending of steel plates used in surgery. METHODS: The dorsal radial tilt was measured using both computed tomography (CT) and x-ray from both left and right side. The differences and correlations of the data measured by those two methods and from two sides were analyzed. RESULTS: The tilts measured by x-ray were significantly bigger than those measured by CT from the left side (t=55.51, p < 0.01) and from the right side (t=49.81, p < 0.01). The tilts measured by those two methods from the left and right sides were correlated (r=0.85, p < 0.01; r=0.81, p < 0.01). The dorsal radial tilts measured from the left side were not significantly different from those measured from the right side by CT (t=1.49, p > 0.05) and by x-ray (t=1.51, p > 0.05). The dorsal radial tilts measured from the left side by CT were significantly different from those measured from the right side by x-ray (t=43.07, p < 0.01), and these two sets of data were correlated (r=0.71, p < 0.01). The dorsal radial tilts measured from the left side by x-ray was significantly different from that measured from right side by CT (t=40.43, p < 0.01), and those two sets of data were also correlated (r=0.75, p < 0.01). Conclusions: The dorsal radial tilts measured from one side by one method can be used to estimate the tilts measured from the other side / the same side by the same method / the other method.

RESUMO OBJETIVO: Realizamos este estudo para definir e medir a inclinação radial dorsal, e para orientar a redução das fraturas do raio distal e a pré-flexão das chapas de aço utilizadas na cirurgia. MÉTODOS: A inclinação radial dorsal foi medida usando tomografia computadorizada (TC) e raios X dos lados esquerdo e direito. As diferenças e correlações dos dados medidos por esses dois métodos e de dois lados foram analisadas. RESULTADOS: As inclinações medidas por raios X foram significativamente maiores que as medidas pela TC do lado esquerdo (t=55,51, p<0,01) e do lado direito (t=49,81, p<0,01). As inclinações medidas por esses dois métodos dos lados esquerdo e direito foram correlacionadas (r=0,85, p<0,01; r=0,81, p<0,01). As inclinações radiais dorsais medidas a partir do lado esquerdo não foram significativamente diferentes das medidas do lado direito por CT (t=1,49, p>0,05) e por raios X (t=1,51, p>0,05). As inclinações radiais dorsais medidas a partir do lado esquerdo por TC foram significativamente diferentes das medidas a partir do lado direito por raios X (t=43,07, p<0,01), e esses dois conjuntos de dados foram correlacionados (r=0,71, p<0,01). As inclinações radiais dorsais medidas a partir do lado esquerdo por raios X foram significativamente diferentes das medidas do lado direito por CT (t=40,43, p<0,01), e esses dois conjuntos de dados também foram correlacionados (r=0,75, p<0,01). CONCLUSÕES: As inclinações radiais dorsais medidas de um lado por um método podem ser usadas para estimar as inclinações medidas do outro lado/o mesmo lado pelo mesmo método/o outro método.

Luxación anterior aislada e irreductible de la cúpula radial en un paciente pediátrico: un raro reporte de caso / Isolated irreducible anterior radial head dislocation in a child: a rare case report

La luxación de la cabeza radial suele asociarse a fractura o deformidad plástica cubital. La luxación aislada es rara. Sin tratamiento, puede evolucionar hacia deformidad cubital en valgo, lesión nerviosa, artrosis precoz y pérdida del rango de movilidad con limitación funcional. Se presenta a un paciente de 9 años que sufrió traumatismo de codo. Acudió a nuestra Institución a los 40 días y se diagnosticó luxación irreductible de la cabeza radial, primero desapercibida. La luxación era irreductible por un ojal en el ligamento anular y requirió ser reducida a cielo abierto. En ausencia de fractura, incluso sin evidencia de deformidad plástica del cúbito, debe sospecharse la luxación de la cabeza radial. La clínica, junto con el par radiográfico bilateral y el conocimiento de esta entidad poco frecuente, son el trípode necesario para alcanzar el diagnóstico y no demorar el tratamiento.

Anterior radial head dislocation in pediatric population is related to Monteggia fracture-dislocations. Isolated radial head dislocation is uncommon. Sometimes, radial head dislocation becomes irreducible. This entity can develop into chronic conditions such as nerve injuries, early osteoarthritis, limited range of motion and cubitus valgus. We describe a case of a 9-year-old patient who suffered elbow trauma. He was admitted to our institution 40 days after, where radial head dislocation was diagnosed. This condition was misdiagnosed at first stage. It was irreducible due to a tear in the annular ligament. He underwent open reduction. Radial head dislocation must be suspected even if there are no fractures or plastic deformity. Pure irreducible radial head dislocation is rare. Physical examination, together with plain bilateral radiographs and full acknowledgement of this rare condition are the basis to reach early diagnosis, which leads to proper non-delayed treatment.

Evaluación radiológica de muñeca para visualizar la superficie articular del radio / Wrist X ray for analysis of the articular surface of distal radius

Resumen: En la fractura del radio distal se requieren proyecciones radiológicas que permitan ver adecuadamente la superficie articular sin interposición de estructuras. El objetivo fue determinar si las proyecciones radiológicas laterales a 7 y 22o mejoran el análisis de esta superficie. Método: Serie de casos con radiografías de pacientes sanos y operados para identificar las facetas del semilunar y escafoides en las proyecciones lateral y anteroposterior, igualmente se evaluó con tornillos. Se analizaron cualitativamente los hallazgos obtenidos en las radiografías de 7 y 22o para la proyección lateral y de 11o en la anteroposterior. Resultados: 14 radiografías de voluntarios sanos, 10 pacientes con fractura de radio que recibieron osteosíntesis y dos piezas anatómicas. En los 14 sanos y los 10 pacientes se encontró que en las proyecciones a 7 y 22o pueden apreciarse mejor las carillas radio-semilunar y radio-escafoides respectivamente, observando imágenes con menor superposición de estructuras en la radiografía de 22o tanto en los sanos como en los pacientes con fracturas. Discusión: Las proyecciones radiológicas son importantes para poder determinar los resultados inmediatos de una osteosíntesis realizada en una fractura de radio distal. En este estudio se observa que la proyección lateral a 7o identifica mejor la posición de los tornillos ubicados en la carilla semilunar del radio. La proyección lateral a 22o muestra mejor la carilla con el escafoides. Por último en la proyección anteroposterior a 11o nos permite ver la articulación radiocarpiana con menor superposición de imágenes.

Abstract: In the distal radius fracture requires radiographic views that allow you to see the articular surface without interposition. The objective was to determine whether lateral radiographic projections 7 and 22o improve the analysis of this surface. Method: Case series study with radiographs of healthy and operated patients, in order to identify the lunate and scaphoid facets in lateral and anteroposterior projections. Qualitative analysis was made on the radiographs of the distal radius with wedges of 7 and 22o in the lateral views and 11o in the anteroposterior view. Results: There were evaluated 14 radiographs of the distal radius of healthy volunteers and 10 patients with distal radius fractures who recieved surgery with internal fixation, and also two anatomical models. In 14 healthy and 10 patients, it was found that the views at 7 and 22o can be better appreciated radio lunate and radio scaphoid surface respectively, observing images with less overlapping in the radiograph of 22o in both groups. Discussion: Radiographic views are important to determine the immediate results of fixation on a distal radius fracture. We observe that the lateral view at 7o is better to show the screws on the lunate facet of the radius. The lateral view at 22o is better to show the facet of the radius with the scaphoid. Finally, the anteroposterior projection at 11o allows us to see the radio carpal joint with lower image overlay.

Korean Type Distal Radius Anatomical Volar Plate System: A Preliminary Report

BACKGROUND: Distal radius fracture is the most common fracture of the upper extremity, and approximately 60,000 distal radius fractures occur annually in Korea. Internal fixation with an anatomical volar locking plate is widely used in the treatment of unstable distal radius fractures. However, most of the currently used distal radius anatomical plate systems were designed based on the anatomical characteristics of Western populations. Recently, the Korean-type distal radius anatomical volar plate (K-DRAVP) system was designed and developed based on the anatomical characteristics of the distal radius of Koreans. The purpose of this study was to evaluate the preliminary results of the new K-DRAVP system, and to compare its radiologic and functional results with those of the other systems. METHODS: From March 2012 to October 2012, 46 patients with acute distal radius fractures who were treated with the K-DRAVP system at three hospitals were enrolled in this study. Standard posteroanterior and lateral radiographs were obtained to assess fracture healing, and three radiographic parameters (volar tilt, radial inclination, and radial length) were assessed to evaluate radiographic outcomes. The range of motion and grip strength, the Gartland and Werley scoring system, and the disabilities of the arm, shoulder and hand (DASH) questionnaire were used to assess clinical and functional outcomes. RESULTS: All radiologic parameters were restored to normal values, and maintained without any loosening or collapse until the time of final follow-up. Grip strength was restored to 84% of the value for the unaffected side. The mean range of motion of the wrist at final follow-up was restored to 77%-95% of the value for the unaffected side. According to the Gartland and Werley scoring system, there were 16 excellent, 26 good, and 4 fair results. The mean DASH score was 8.4 points. There were no complications after surgery. CONCLUSIONS: The newly developed K-DRAVP system could be used to restore and maintain good anatomical parameters, and provide good clinical outcomes with low complication rates. This system is a promising surgical option for the treatment of distal radius fractures in the Korean population.

Gradual Lengthening of the Ulna in Patients with Multiple Hereditary Exostoses with a Dislocated Radial Head

PURPOSE: Multiple hereditary exostoses of the forearm typically form in the distal ulna, causing disturbances in the growth of the ulna and functional disability. Multiple hereditary exostoses inhibit the growth of the ulna, leading to an acquisition of a varus deformity in the radius, which sometimes leads to dislocation of the radial head, the development of limitations in the pronation-supination of the forearm, and cosmetic problems. MATERIALS AND METHODS: We retrospectively reviewed the cases of four patients who had deformities of the forearm with radial head dislocation associated with multiple hereditary exostoses, and evaluated the radiologic and clinical results of excision of the osteochondromas from the distal ulna and gradual ulnar lengthening with an Ilizarov external fixator. RESULTS: Good clinical and radiological results were obtained after a mean follow-up of 25 months. At the most recent follow-up, radial bowing, ulnar shortening, carpal slip, and the pronation/supination arch of the forearm had improved. There was little change in terms of preoperative radial articular angle and the flexion/extension arch of the elbow by the most recent follow-up. CONCLUSION: Treatment of four forearms from four patients by excision of osteochondromas and gradual lengthening of the ulna with an Ilizarov external fixator spontaneously reduced dislocations of the radial heads without the need for any additional operative intervention. All patients were satisfied with the final results.

Trend of bone development of adolescent at 14 years old / 法医学杂志

OBJECTIVE@#To describe characteristic of hand-wrist bone development in adolescents of 14 years old in China, and to estimate trend of bone development of them.@*METHODS@#A total of 109 adolescents of 14 years was selected as subjects (males: 53, females: 56). X-rays examination of their left hand-wrist bone were performed and analyzed. The development characteristics of each position in accordance with Gu's mapping of skeletal age were compared with Gu's results and ours.@*RESULTS@#Compared with Gu's, osteoepiphysis of distal radius, the first metacarpal bone, the fourth proximal phalanx were more advanced in boys, osteoepiphysis of distal radius, the second-fifth metacarpal bones, the first-fifth proximal phalanxs, and the second-fifth middle phalanxs were more advanced in girls.@*CONCLUSION@#The results suggested that a forward trend of 14 years old adolescents bone development currently exists in our country, especially in girls. As an important age of criminal responsibility, this forward trend of development of bones among adolescents currently should be kept in mind when estimating bone age of criminals.

Development of hand-wrist bones of 14 year-old adolescents. II. Standard of bony age for girls / 法医学杂志

OBJECTIVE@#To study the current development of hand-wrist bones of adolescents in China, and establish special forensic bony age standard for estimating 14 years of criminal responsible age in female adolescents.@*METHODS@#One hundred and ten healthy girls aged from 13 years and 9 months to 14 years and 3 months in Lengshuijiang district of Hunan province were enrolled in this study. X-ray films of their left hand-wrists were taken dorsaventrally, and 15 sites on the wrist x-ray films were examined and measured under standard condition. The development grade was confirmed by maximal percentage to establish a method to estimate the bony age, which was then checked by single blind method.@*RESULTS@#Development grade of the radius, the middle third phalanx and the fourth phalanx was partially closed (> 2/3), and the rest was wholly-closed with existence of the epiphyseal line. The development grade of the middle third phalanx and fourth phalanx was different between the younger group (< 14 years, partially closed, > 2/3) and the older group (> 14 years, mostly closed with existence of only epiphyseal line). The cross diameter of the osteoepiphysises were wider than that of all the diaphysises. The confirmed accuracy (in 30 girls) was 83.3%.@*CONCLUSION@#Our study seemes to be feasible in establishing the estimation standard for bony age determination. The standard established by developmental metaphysis and authropometry may be particularly helpful in forensic practice for estimation of accurate criminal responsible age in adolescents.

Stature estimation from upper extremity long bones by digital radiography / 法医学杂志

OBJECTIVE@#To obtain regression formula for estimation of stature in Han population in Sichuan Province from length of the upper extremity long bones by digital radiography.@*METHODS@#The statures of 365 healthy adults and digital radiographs of their right upper extremity long bones were measured. All statistical dispositions were done in SPSS including description and regression analysis.@*RESULTS@#Twenty-seven simple regression and 3 multiple regression formulae with statistic significance in estimation of the stature from the sum of the length of the upper extremity long bones were established. Regression coefficient was higher in ulna than in radius, in male than in female, and was more accurate in multiple regression formulae than in simple regression formulae.@*CONCLUSION@#Digital radiograph measurement of the length of the upper extremity long bones seems to be a simple and practical method to estimate human stature in forensic practice.

Development and prospect on skeletal age evaluation methods of X-ray film / 法医学杂志

The traditional methods of skeletal age estimation mainly include Numeration, Atlas, and Counting scores. In recent years, other new methods were proposed by several scholars. Utilizing image logical characteristics of X-ray film to extrapolate skeletal age is a key means by present forensic medicine workers in evaluating skeletal age. However, there exist some variations when we present the conclusion of skeletal age as an "evidence" directly to the Justice Trial Authority. In order to enhance the accuracy of skeletal age determination, further investigation for appropriate methodology should be undertaken. After a collective study of pertinent domestic and international literatures, we present this review of the research and advancement on skeletal age evaluation methods of X-ray film.

Role of dynamic external fixator in the management of fractures of distal end of radius.

The intra-articular fracture of radius has been an enigma for orthopaedic surgeons since time immemorial. It is a dilemma as to when to use the fixator, when to mobilise after fixator or simply treat it by conservative means. Numerous fixators are in vogue depending on the preference of the surgeon--in the present prospective study the results of dynamic external fixator--which, based on the principle of ligamentotaxis, were evaluated over a 3-year period and the results showed that although excellent radiological results were seen in 90% of the cases yet only 75% of the cases had a excellent functional result.

The differences between left & right side development of osteophiphysis in estimating male juvenile age / 法医学杂志

OBJECTIVE@#The influence on age estimation by comparing the differences between left and right side development of osteophiphysis.@*METHODS@#27 osteophiphysis development indexes in the X-ray films of 6 major joints and pelvises in 130 male juveniles were observed. The positions and levels of difference between left and right side development of osteophiphysis were compared. The male juvenile age by regression equation according to left side and right side were estimated respectively.@*RESULTS@#In 76 cases, the age estimation results are the same for both sides. In 47 cases, the difference between left and right side is less than 6 months. In 7 cases, the difference is between 6 and 12 months. The error of 94.6% age estimation is within 6 months. The differences between left and right osteophiphysis development are often found in proximal humerus, distal radius, distal ulna and crista iliaca.@*CONCLUSION@#The subtle difference between left and right osteophiphysis development has no influence on age estimation.

effect of bone marrow graft on bone healing: a radiological and biomechanical study

There are multiple methods for acceleration of bone healing. Bone marrow has been shown to contain osteoprogenitor cells. To determine the effect of percutaneous bone marrow injection on bone healing. 15 mature, 2-kg-weighing white New Zealand rabbits from both sexes were randomized into 3 groups: Group I: Only osteotomy of right radius was performed and a 5 mm bony defect was made. Group II: Same as group I, with the defect filled by bonegraft, taken from the iliac crest. Group III: Same as group I plus percutaneous bone marrow injection 5 days after the operation. 45 days post-operation, the rabbits were sacrificed. The radii of both forelimbs were isolated and tested by tensile testing machine. There was a significant difference between groups I and III [p<0.001] for toleration of maximum load and bending stiffness. No significant difference was observed between groups II and III for these parameters. Bone marrow injection has an effect on bone healing comparable to bone grafting. This technique is non-invasive and simple without any significant complication

The accuracy of bone mineral density at distal radius on non-forearm osteoporosis identification.

The accuracy of BMD at distal radius was evaluated in terms of sensitivity, specificity, false negative, false positive, predictive value of a positive (osteoporosis) and a negative (normal) test for non-forearm osteoporosis. 278 women (150 osteoporotic and 128 normal) were measured for both distal radius bone mineral density (BMD) using Panasonic (DXA-70) dual energy X-ray absorptiometry (DEXA) and non-forearm BMD using Hologic (QDR-4500) DEXA on the same day. The results showed that mean age, menopause age, height and weight in the osteoporotic group were not different from the healthy group (p=0.168, 0.091, 0.274 and 0.097, respectively). Mean BMD of both distal radius and lumbar spine in the normal women was significantly higher than that in the osteoporotic group (p<0.001, = 0.002, <0.001, respectively). While mean BMD of the hip, femoral neck and Ward's triangle in both groups was not different (p = 0.330, 0.874, 0.847, respectively). The sensitivity of BMD of the right radius was very high (90.00-95.45%) and specificity was moderately high (53.85-73.68%). While false negative (4.55-10.00%) was less than false positive (26.32-46.15%). The accuracy of right radius BMD when compared with spine, hip, femoral neck and Ward's triangle was 82.35, 66.66, 80.00 and 86.49 per cent, respectively. The sensitivity (85.00-96.67%), specificity (57.69-81.58%), false negative (3.33-15.00%) and false positive (18.42-42.31%) of left radius BMD had the same trend as right radius BMD. Accuracy of the left radius when compared with non-forearm BMD was 88.24, 66.67, 75.71 and 86,49 per cent, respectively. The predictive value of right radius osteoporosis was 73.68, 47.37, 77.78 and 89.66 per cent for detecting osteoporosis at spine, hip, femoral neck and Ward's triangle, respectively. The predictive value of normal right radius BMD was 93.33, 92.86, 87.50 and 75.00 per cent, respectively for normal non-forearm BMD. Moreover, the predictive value of left radius osteoporosis for identifying spinal, hip, femoral neck and Ward's triangle osteoporosis was (80.56, 47.22, 77.55 and 91.07%, respectively) and the predictive value of normal left radius BMD for identifying normal BMD at non-forearm sites (96.88, 90.00, 71.43 and 72.22%, respectively) was revealed. It indicated that forearm DEXA provides adequate accuracy for in vivo determination of spinal, femoral neck and Ward's triangle osteoporosis. However, there was inadequate accuracy and very low predictive ability for identifying hip osteoporosis.

Giant cell tumour of the lower end of the radius--a new treatment modality.

Excision of the lower end of the radius with centralisation of ulna was done in 3 patients with histology proved diagnosis of giant cell tumour, as secondary procedure in 2 cases following recurrence of tumour in the fibular graft, and as a primary procedure in one, where the segment of fibula required was more than 15.2 cm. After an average follow-up of 2.3 years, the results were assessed both subjectively and objectively. The patients were happy with their hand functions and were able to have more than 80% of the grip strength. They could return to their former occupation. There was no recurrence of tumour and no pain at the wrist.