Does Surgery Improve Healing After Isolated Diaphyseal Ulna Fractures?

PURPOSE: Isolated diaphyseal ulna fractures can be treated nonsurgically or with open reduction and internal fixation (ORIF). It is unclear whether ORIF provides quicker and/or more predictable healing. The purpose of this study was to compare the healing characteristics of isolated diaphyseal ulna fractures after surgical and nonsurgical treatment. METHODS: All patients treated for an isolated diaphyseal (distal- or middle-third) ulna fracture between 2010 and 2018, with a minimum of 3 months of follow-up, were identified. Electronic medical records were reviewed to record patient demographics, assess the treatments used, and compare outcomes. We determined healing and nonunion rates, complications, reoperations, and final radiographic fracture alignment. RESULTS: Ninety-five patients were included with a median follow-up of 20 weeks. Of these, 56 patients were treated nonsurgically and 39 patients were treated with ORIF. At the time of the final follow-up, 51 of the 56 (91.1%) nonsurgically treated fractures had healed and 38 of the 39 (97.4%) surgically managed fractures had healed. There were 5 nonunions after nonsurgical treatment (8.9%) and 1 nonunion after ORIF (2.6%). Eleven patients (19.6%) treated nonsurgically required conversion to ORIF, whereas 4 patients (10.3%) treated with ORIF required reoperation. Middle-third fractures treated nonsurgically had a higher rate of nonunion (30.8%) compared with distal-third fractures treated nonsurgically (2.3%). CONCLUSIONS: The healing characteristics of isolated ulnar shaft fractures do not appear to differ substantially between surgical and nonsurgical treatment. However, nearly 20% of the patients treated nonsurgically may require eventual ORIF. Distal-third fractures may be at a higher risk of conversion to ORIF, and middle-third fractures may be at a higher risk of nonunion. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Olecranon fractures: do they lead to osteoarthritis? Long-term outcomes and complications.

PURPOSE: To report radiologic, functional outcomes, and complications with a long-term follow-up in acute olecranon fractures treated with osteosynthesis and, secondly, to determine the predisposing factors to arthritis. METHODS: Forty-two patients treated with osteosynthesis for acute olecranon fractures were reviewed, with a minimum follow-up of 24 months. Radiological and clinical evaluations including DASH, MEPS, active range of motion, pain, arthritis, associated lesions, and complications were recorded. Arthritis was classified according to Broberg-Morrey scale. A logistic regression model was estimated to determine risk factors to develop ulnohumeral arthritis. The association between the types of fractures according to Mayo classification and MEPS, and the association between the type of fracture and the presence of pain were analyzed. RESULTS: The average follow-up was of 43.64 months. The flexion-extension average range was 135.6°, and the mean MEPS was 89.45; the DASH was 25.26. Eighteen cases (42.86%) were fixed with pre-contoured locking plates, 21 with tension band wiring (50%), and 3 with cannulated screws of 7 mm (7.14%). Six cases (14.29%) needed hardware removal. All fractures healed. Ulnohumeral osteoarthritis was observed in 14 cases (33.3%). We did not find a significant association among the MEPS, pain, and the fracture type, according to Mayo (p > 0.1 for both values). A significant association was found (p < 0.05) between fracture type and the osteoarthritis. CONCLUSIONS: In olecranon fractures, good functional and radiological results with low complications are predictable. The osteoarthritis is possible in more complex fractures and with other associated fractures.

Bipolar Disruption of the Lateral Ulnar Collateral Ligament of the Elbow: A Case Report.

CASE: The lateral ulnar collateral ligament (LUCL) is one of the primary stabilizers of the elbow. Disruption typically occurs from the humeral origin and may be because of an elbow dislocation or fracture/dislocation. If not identified and properly managed, posterolateral rotatory instability may result from LUCL insufficiency. We describe the case of a patient with bipolar LUCL disruption consisting of an avulsion fracture of the crista supinatoris and a soft-tissue avulsion from the lateral epicondyle. CONCLUSION: Bipolar disruption of the LUCL is a previously unreported injury pattern that may lead to posterolateral instability if not identified and treated.

Aloenxertos ósseos e enxerto sintético de hidroxiapatita em falha óssea ulnar em galinhas (Gallus gallus domesticus), aspectos radiográficos e histológicos / Bone allografts and synthetic grafts hydroxyapatite on ulnar bone defect in fowl (Gallus gallus domesticus), radiographic and histological aspects

Dos atendimentos ortopédicos realizados em aves no HCV-UFRGS, 86% são fraturas, sendo aproximadamente 30% delas cominutivas com perda óssea expressiva, justificando a importância da utilização de enxertos em fraturas de aves. O objetivo deste trabalho foi avaliar dois aloenxertos e enxerto sintético de hidroxiapatita em defeito ósseo de galinhas. Utilizaram-se 30 galinhas separadas em três grupos: aloenxerto congelado em ultra-freezer (GUF), aloenxerto congelado em nitrogênio líquido (GNL) e enxerto sintético de hidroxiapatita deficiente em cálcio (GHA). Nos três grupos, os enxertos foram aplicados com placas e parafusos bloqueados de 2mm na ulna direita das aves, avaliando-se a evolução por meio de exames radiográficos até serem completados 90 dias de pós-operatório e o resultado final mediante exame histológico. A média e desvio-padrão relacionando o tempo de consolidação óssea radiográfica foi: GNL 61,67±21,79 dias (90% de consolidação), GUF 47,14±13,50 dias (70% de consolidação) e GHA 70±18,17 dias (60% de consolidação). Houve diferença significativa no tempo de consolidação óssea entre o GUF e o GHA. Histologicamente, os enxertos do GUF foram os que estavam em consolidação mais avançada. Os aloenxertos do GNL foram superiores no preenchimento de falha óssea ulnar de galinhas.(AU)

Of the orthopedic visits performed on birds at HCV-UFRGS, 86% are fractures, and approximately 30% of them are comminuted with expressive bone loss, justifying the importance of the use of grafts in bird fractures. The objective of this work was to test two allografts and a synthetic HADC graft on finishing in Gallus gallus domesticus. 30 laying hens were used, divided in three groups: frozen allograft in ultrafreezer (UFG); frozen allograft in liquid nitrogen (LNG); calcium deficient synthetic hydroxyapatite graft (HAG). The three graft groups were exposed to serial radiographs until the 90 postoperative days, as well as the histological examination at the end of the experiment were: LNG 61.67±21.79 days (90% consolidation), UFG 47.14±13.50 days (70% consolidation) and HAG 70±18.17 days (60% consolidation). There was a significant difference in bone healing time between GUF and GHA. Histologically, GUF grafts were the ones that were in the most advanced consolidation. LNG allografts were superior in filling ulnar bone failure of fowl.(AU)

Aloenxertos ósseos e enxerto sintético de hidroxiapatita em falha óssea ulnar em galinhas (Gallus gallus domesticus), aspectos radiográficos e histológicos / Bone allografts and synthetic grafts hydroxyapatite on ulnar bone defect in fowl (Gallus gallus domesticus), radiographic and histological aspects

Dos atendimentos ortopédicos realizados em aves no HCV-UFRGS, 86% são fraturas, sendo aproximadamente 30% delas cominutivas com perda óssea expressiva, justificando a importância da utilização de enxertos em fraturas de aves. O objetivo deste trabalho foi avaliar dois aloenxertos e enxerto sintético de hidroxiapatita em defeito ósseo de galinhas. Utilizaram-se 30 galinhas separadas em três grupos: aloenxerto congelado em ultra-freezer (GUF), aloenxerto congelado em nitrogênio líquido (GNL) e enxerto sintético de hidroxiapatita deficiente em cálcio (GHA). Nos três grupos, os enxertos foram aplicados com placas e parafusos bloqueados de 2mm na ulna direita das aves, avaliando-se a evolução por meio de exames radiográficos até serem completados 90 dias de pós-operatório e o resultado final mediante exame histológico. A média e desvio-padrão relacionando o tempo de consolidação óssea radiográfica foi: GNL 61,67±21,79 dias (90% de consolidação), GUF 47,14±13,50 dias (70% de consolidação) e GHA 70±18,17 dias (60% de consolidação). Houve diferença significativa no tempo de consolidação óssea entre o GUF e o GHA. Histologicamente, os enxertos do GUF foram os que estavam em consolidação mais avançada. Os aloenxertos do GNL foram superiores no preenchimento de falha óssea ulnar de galinhas.(AU)

Of the orthopedic visits performed on birds at HCV-UFRGS, 86% are fractures, and approximately 30% of them are comminuted with expressive bone loss, justifying the importance of the use of grafts in bird fractures. The objective of this work was to test two allografts and a synthetic HADC graft on finishing in Gallus gallus domesticus. 30 laying hens were used, divided in three groups: frozen allograft in ultrafreezer (UFG); frozen allograft in liquid nitrogen (LNG); calcium deficient synthetic hydroxyapatite graft (HAG). The three graft groups were exposed to serial radiographs until the 90 postoperative days, as well as the histological examination at the end of the experiment were: LNG 61.67±21.79 days (90% consolidation), UFG 47.14±13.50 days (70% consolidation) and HAG 70±18.17 days (60% consolidation). There was a significant difference in bone healing time between GUF and GHA. Histologically, GUF grafts were the ones that were in the most advanced consolidation. LNG allografts were superior in filling ulnar bone failure of fowl.(AU)

The Community Orthopedic Surgeon Taking Trauma Call: Pediatric Distal Radius and Ulna Fracture Pearls and Pitfalls.

Distal radius and ulna fractures are common injuries in children. Fractures typically involve the distal radius and ulna metaphysis or physis or a combination of the 2. The goals of treatment are aimed at achieving satisfactory anatomic alignment within defined parameters based on growth remaining. Nonoperative treatment approaches are recommended for most fractures, whereas surgical intervention is indicated for select cases. Potential issues with skeletal growth and bone remodeling are common. This article will offer evidence- and experience-based pearls regarding common closed fractures of the distal radius and ulna intended to benefit the community orthopaedic surgeon caring for children during the course of their on-call duties.

Comparative Study of Internal Fixation of the Ulna and Distal Ulna Resection in Patients Older Than 70 Years With Distal Radius and Distal Metaphyseal Ulna Fractures.

Background: Acute management of fractures of the distal ulna that are associated with fractures of the distal radius remains difficult, particularly in the elderly. Methods: In this study, we investigated whether internal fixation of the distal ulna is associated with a higher rate of complications than resection of the distal ulna in patients older than 70 years. Twenty-four consecutive patients were included in this study, 12 of whom had undergone open reduction and internal fixation (ORIF) of the distal ulna, and 12 who had undergone distal ulna resection. Patients were retrospectively assessed for range of motion, grip strength, pain, and radiographic appearance. The functional outcome was evaluated by the Mayo Wrist Score. Complications were classified according to the Classification of Surgical Complications. Results: There were no differences in patient demographics between the 2 groups, except patient age. Clinical evaluation showed no difference at follow-up; however, there were significantly more complications associated with ORIF compared with resection. Conclusions: The results from our study show that women older than 70 years with fracture of the distal radius and distal ulna have a higher rate of complications if ORIF of the distal ulna is performed. Patients should be warned, by surgeons, of this in cases where ORIF of the distal ulna is suggested.

Fragmento dorso-ulnar en fracturas de radio distal: clasificación y manejo / Dorso-ulnar fragment in distal radius fractures: classification and treatment

INTRODUCCIÓN: El fragmento dorso-ulnar (FDU) en la fractura intraarticular de radio distal es de especial importancia puesto que implica una alteración en la articulación radio-carpiana así como también en la articulación radio-ulnar distal (RUD), donde la incongruencia articular permanente puede generar secuelas a largo plazo. OBJETIVO: Proponer una clasificación del FDU, definiendo cuándo realizar el procedimiento quirúrgico con asistencia artroscópica, basado en una serie consecutiva de casos operados de fractura del radio distal estudiados con tomografía computada (TC). MÉTODO: Estudio descriptivo de una serie de casos de pacientes operados por fractura del radio distal entre enero del 2015 y diciembre del 2016. En base a eso, se elabora una clasificación del FDU y se sugiere un esquema de manejo específico. Se describe el FDU como aquel fragmento específico ubicado en la esquina dorso-ulnar de la carilla articular del radio distal, con compromiso de más del 30% de la superficie articular RUD y más de 5mm desde el borde ulnar hacia radial de la cortical dorsal del radio observado en el corte axial de la TC preoperatoria. Se considera un fragmento mayor (FM) cuando el rasgo de fractura compromete hacia radial hasta el tubérculo de Lister y se considera fragmento menor (Fm) cuando el rasgo no alcanza a comprometer el tubérculo de Lister. Nuestra propuesta de clasificación reconoce 4 tipos: tipo I (FM sin desplazamiento, en fracturas tipo C de la AO); tipo II (FM con desplazamiento, en fracturas tipo C de la AO); tipo III (Fm independiente del desplazamiento, en fracturas tipo C de la AO) y tipo IV (FM/Fm con desplazamiento, en fracturas tipo B2 de la AO). Esquema de manejo: Tipo I síntesis con placa bloqueada por abordaje palmar, sin obligación de asistencia artroscópica. Tipo II síntesis con placa bloqueada por abordaje palmar, con asistencia artroscópica requerida. Tipo III síntesis percutánea dorsal contornillo canulado, bajo asistencia artroscópica. Tipo IV síntesis dorsal con placa o tornillo mediante abordaje dorsal bajo visión directa o con asistencia artroscópica, usando portales artroscópicos volares. RESULTADOS: Se operaron 488 fracturas de radio distal durante el período mencionado; 375 fracturas clasificadas como tipo C de la AO. Del total operadas, solo 392 fracturas contaban con TC peroperatoria, que permitía evaluar la presencia del FDU, el cual estuvo presente en 127/392 de los casos (32,4%). Analizados por grupo, 38 casos presentaban fragmentos tipo I, 22 tipo II, 69 tipo III y 7 tipo IV. DISCUSIÓN: El FDU se presentó en un 32,4% de los casos evaluables por TC en nuestra serie. El manejo dirigido de este fragmento con asistencia artroscópica permitió una reducción anatómica con fijación estable específica de éste. CONCLUSIÓN: Proponemos una nueva clasificación del FDU basada en la TC preoperatoria que permite realizar un adecuado plan prequirurgico y abordar este fragmento de manera específica sugiriendo cuando utilizar asistencia artroscópica.

INTRODUCTION: The dorsal-ulnar fragment (DUF) in the distal radius fracture is of special importance since it implies an alteration in the radio-carpal joint as well as in the distal radio-ulnar joint (DRUJ), where permanent joint incongruence can generate long-term sequelae. OBJECTIVE: To propose a classification of the DUF, advising when to perform arthroscopic assistance, based on a consecutive series of operated cases of distal radius fracture studied with computed tomography (CT). METHODS: Descriptive study of a series of cases of patients operated of distal radius fracture between January 2015 and December 2016. We describe a classification of the DUF and suggest a specific treatment scheme. The DUF is described as that specific fragment located in the dorso-ulnar corner of the articular surface of the distal radius, which involves more than 30% of the articular surface of the DRUJ and more than 5mm of the ulnar edge of the dorsal cortex of the radius observed in the axial section of the preoperative CT. It is considered a major fragment (FM) when the fracture compromises the Lister tubercle and is considered a minor fragment (Fm) when it does not. Our classification recognizes 4 types of DUF: type I (FM without displacement, in type C fractures of the AO); Type II (FM with displacement, in type C fractures of the AO); Type III (Fm independent of displacement, in fractures type C of the AO) and type IV (FM/Fm with displacement, in fractures type B2 of the AO). Treatment scheme: Type I: synthesis with a palmar locked plate without arthroscopic assistance required. Type II: synthesis with palmar locked plate with arthroscopic assistance. Type III dorsal percutaneous synthesis with cannulated screw with arthroscopic assistance. Type IV dorsal synthesis with plate or screw by dorsal approach under direct vision or with arthroscopic assistance using volar portals. RESULTS: A total of 488 distal radius fractures were operated during this period. Only 392 fractures had preoperative CT, which allowed to evaluate the presence of the DUF. It was present in 127/392 of the cases (32.4%). Analyzed by group, 38 cases presented fragments type I, 22 cases type II, 69 cases type III and 7 cases type IV. DISCUSSION: The DUF was presented in 32.4% of the cases in our series. The management of this fragment with arthroscopic assistance allowed an anatomical reduction with specific stable fixation of this fragment. CONCLUSION: We propose a novel classification of the DUF based on preoperative CT that allows a specific management of this fragment and suggest when to use arthroscopic assistance.

Forearm diaphyseal fractures in children: intramedullary Kirschner's wire fixation treatment. / Fracturas diafisarias del antebrazo en niños: tratamiento con fijación intramedular con clavos de Kirschner.

INTRODUCTION: Diaphyseal fractures of the forearm comprise 6%-10% of all fractures in children. The treatment depends on the age and type of displacement, and conservative and surgical management with fixation of intramedullary nails, among other techniques, is valid. The aim is to show the radiological and functional outcomes, and complications of intramedullary fixation with Kirschner nails in children. MATERIALS AND METHODS: A retrospective descriptive case series of patients treated with intramedullary fixation of forearm fractures. The radiological and functional results, and complications are correlated. RESULTS: Of the 117 patients operated, 59 met the inclusion criteria. The average age was 10 years. Eighty-four point seven percent were males and the left side was the most affected (62.7%). In 88.1% both bones were fractured and 11 cases had open fractures. An open reduction was performed in 72.8% of the cases, the main indications for this being instability, failed reduction and refracture. There were 52 excellent outcomes, 2 good, and 4 regular and 1 bad. There were 13.5% minor complications. DISCUSSION: This study shows that intramedullary fixation with Kirschner nails in radius and ulna diaphysis fractures in children is a safe, low-cost procedure and offers adequate short and medium term functional outcomes, with a low prevalence of serious complications with only 6 cases of non-consolidation and refracture. Larger preoperative angulations in the anteroposterior and lateral planes, and lateral postoperative angulations, could be considered predictors of less satisfactory functional results.

Intramedullary Implant Choice and Cost in the Treatment of Pediatric Diaphyseal Forearm Fractures.

OBJECTIVES: To compare outcomes and costs between titanium elastic nails (TENs), stainless steel elastic nails (SENs), and Kirschner wires (K-wires) in the treatment of pediatric diaphyseal forearm fractures with intramedullary fixation. DESIGN: Retrospective cohort study. SETTING: Level 1 Pediatric Trauma Center. PATIENTS/PARTICIPANTS: A total of 100 patients (65 male and 35 female) younger than 18 years with diaphyseal forearm fractures treated with intramedullary fixation were included in the study. INTERVENTION: Patients received single or both bone intramedullary fixation with either TENs, SENs, or K-wires. MAIN OUTCOME MEASUREMENTS: Time to radiographic union, complication rate, surgical time, and average cost per implant. RESULTS: One hundred patients were included in the study. Thirty-one patients were treated with TENs, 30 with SENs, and 39 with K-wires. No significant difference in time to radiographic union, complication rate, or surgical time was found between the 3 types of fixation. Average time to union was 9.4 ± 5.4 weeks, and complication rate was 12.9% for TENs, 10.0% for SENs, and 12.8% for K-wires. There was a significant difference in cost per implant, with an average cost of $639, $172, and $24 for TENs, SENs, and K-wires, respectively (P < 0.001). CONCLUSIONS: This study demonstrates no difference between TENs, SENs, and K-wires in the treatment of pediatric diaphyseal forearm fractures with regards to outcome, time to union, surgical time, or complication rates. Given the significant cost difference between these implants, we recommend that surgeons consider modifying their implant selection to help mitigate cost. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Objective assessment of plaster cast quality in pediatric distal forearm fractures: Is there an optimal index?

BACKGROUND: Several so-called casting indices are available for objective evaluation of plaster cast quality. The present study sought to investigate four of these indices (gap index, padding index, Canterbury index, and three-point index) as compared to a reference standard (cast index) for evaluation of plaster cast quality after closed reduction of pediatric displaced distal forearm fractures. METHODS: Forty-three radiographs from patients with displaced distal forearm fractures requiring manipulation were reviewed. Accuracy, sensitivity, specificity, false-positive probability, false-negative probability, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio were calculated for each of the tested indices. RESULTS: Comparison among indices revealed diagnostic agreement in only 4.7% of cases. The strongest correlation with the cast index was found for the gap index, with a Spearman correlation coefficient of 0.94. The gap index also displayed the best agreement with the cast index, with both indices yielding the same result in 79.1% of assessments. CONCLUSION: When seeking to assess plaster cast quality, the cast index and gap index should be calculated; if both indices agree, a decision on quality can be made. If the cast and gap indices disagree, the padding index can be calculated as a tiebreaker, and the decision based on the most frequent of the three results. Calculation of the three-point index and Canterbury index appears unnecessary.

Agreement of olecranon fractures before and after the exposure to four classification systems.

BACKGROUND: Although classification systems of olecranon fractures are important to help choose the best treatment and to predict prognosis, their degree of observer agreement is poorly investigated. The objective of this study was to investigate the intraobserver and interobserver reliability of currently used classification systems for olecranon fractures. Our hypothesis is that the Colton classification presents an acceptable agreement because it is simpler to use; on the other hand, considering the AO classification's complexity, we expect it to reach a lower level of agreement. METHODS: Radiographic images of elbow joint fractures were classified according to Colton, AO, Mayo, and Schatzker classification systems. The raters were 8 orthopedic surgeons split into 2 groups with 4 participants each, one with specialists in upper extremity surgery and the other with orthopedic surgeons without a specific focus on upper extremity surgery. This first procedure was the pretest training, aimed at calibrating participants' judgment. Image classification was conducted after all training was completed. After 30 days from the initial rating session, the test was conducted once again following the exact same procedures. RESULTS: The Colton classification has substantial intraobserver and interobserver agreement for specialists and nonspecialists. The Schatzker classification revealed a fair agreement for both specialists and nonspecialists. A fair concordance was also found for the Mayo classification. The AO classification demonstrated a moderate rate of agreement for specialists, whereas nonspecialists presented slight intraobserver agreement. CONCLUSION: No classification system is widely accepted because it can be affected by interobserver variability, which can raise questions about its use in a research as well as in a clinical context.

[Multiple fracture of the upper limb. Case report]. / Fractura múltiple en miembro superior. Caso clinic.

Multifocal fractures of the upper limb are infrequent. We report a case of ipsilateral proximal humerus fracture, proximal and distal forearm fractures, and their surgical management.

[Intra-articular distal radial fracture with lunate fossa rotated, about 4 cases: interest of surgical procedure by volar medial approach]. / Fracture articulaire du radius distal avec fragment de fossette lunarienne retourné, à propos de 4 cas : intérêt du traitement chirurgical par voie antéro-médiale.

INTRODUCTION: Intra-articular distal radial fractures in young subjects occur in severe trauma. Articular reduction needs to be anatomical. We report four cases with the particularity of having a 90° or 180° rotated lunate fossa. Our goal is to bring out the positive aspects of surgical procedure by volar medial approach and to assess long-term functionnal and radiological results. MATERIAL AND METHODS: Our study focused on four men whose average age was 27 (age range from 19 to 43). The fractures were type IV according to Melone's classification. The associated lesions included: one fracture of the base of the ulnar styloid, one fracture of the distal quarter of the ulnar diaphysis and one scapho-lunate diastasis. We used a volar medial approach between the flexors tendons and the ulnar bundle in order to pin the fragment of lunate fossa. The rest of the radial epiphysis was pinned after a 5mm skin incision. In two cases, this pinning was complemented with a brachial-antebrachial-palmar cast and in the other two cases with an external fixator. RESULTS: The follow-up period averaged 68.8 (18 to 115) months, all the patients were clinically examined through antero-posterior, lateral and dynamic X-rays. The objective results assessed according to Green and O'Brien's criteria, later modified by Cooney, were as follows: two very good, one good, one average. The X-rays showed consolidated fractures. According to Knirk and Jupiter's classification of arthritis, we had three grades 0, one of which showed a subchondral sclerosis of the lunate fossa, and one grade 3. DISCUSSION AND CONCLUSION: Imaging with simple radiographs is not sufficient and needs to be complemented with CT scan. Our approach allows for direct access to the fragment of the lunate fossa and easier visualization of the distal radioulnar, compared to Henry's approach, thereby avoiding excessive traction of the median nerve. TYPE D'ÉTUDE: Niveau IV.

[Usefulness of the cast index and padding index for the prognosis of pediatric forearm fractures]. / Utilidad del índice de yeso y acolchonamiento en el pronóstico de las fracturas de antebrazo en niños.

BACKGROUND: The most frequent fractures in pediatric patients are those of the mid or distal shaft of the radius and ulna. Most of them can be treated with closed reduction and a brachio-palmar cast, but sometimes redisplacement or angulation occur within the first few weeks. Xray measurements to foresee these complications have been designed; this paper focuses on their certainty and usefulness. METHODS: Twenty-four patients ages 2-14 years of age were included, all of them with closed fractures of the mid or distal shaft of the radius and ulna treated with reduction maneuvers under anesthesis and placement of an brachio-palmar cast. Measurements of the cast, padding and Canterbury indices were performed, which were compared with the clinical and X-ray results at three weeks. The sensitivity, specificity, and the positive and negative predictive value were calculated. RESULTS: X-ray measurements had a sensitivity of 43%, a specificity of 88%, a positive predictive value of 60% and a negative predictive value of 79%. CONCLUSION: The results of the measurements are consistent with the findings of other studies, which proves their usefulness; their use should therefore be encouraged to prevent complications like the displacement or angulation of forearm fractures in pediatric patients.

[Radiographic and functional results of plate of oxnamic ram compression versus plate of compression bolted in radial and cubital fractures]. / Resultados radiográficos y funcionales de placa de compresión dinámica vs placa de compresión acerrojada en fracturas diafisarias de radio y/o cúbito.

OBJECTIVE: To determine if there are statistically significant differences in radiographic and functional outcome in postoperative patients with DCP (dynamic compression plate) vs. LCP (locking compression plate) in fractures radial and/or ulnar shaft. MATERIAL AND METHODS: Quasi-experimental, observational, longitudinal, comparative and prospective study, with patients surgically stabilized using the implants mentioned before with diaphyseal forearm fractures in the Balbuena General Hospital from September 1st to February 28th of 2005, with 2 years of follow-up. RESULTS: 22 patients were surgically stabilized with dynamic compression plate and 11 with locking compression plate, gender male in 88%, predominantly in 3rd life decade, earlier consolidation in the group of locking compression plate but with greater functional limitation. The differences decreased after 3 months and 6 months of clinical follow up, with no statistically significant differences at 2 years of follow-up. CONCLUSIONS: Although there are differences at the 1st and 3rd months of postoperative period, attributable to stability provided by each one of the implants, the beginning of mobilization and the soft-tissue handling, there are no statistically significant differences in the preliminary results at 6 months and finally at 2 years of follow-up. We consider that implants in study, even though of acting in a relatively different way, both of them are excellent alternatives of treatment in patients with forearm shaft fractures.

[Bone mineral density, milk intake and physical activity in boys who suffered forearm fractures]. / Densidade mineral óssea, ingestão de leite e atividade física de meninos que sofreram fraturas no antebraço.

OBJECTIVE: To compare boys with and without forearm fracture in terms of their bone mineral density, intake of milk and dairy products, and physical activity. METHODS: There were 23 boys in each group (aged between 7 and 13 years). They were submitted to bone densitometry with dual-energy x-ray absorptiometry (DEXA) of the forearm (opposite side of the fracture). Participants answered questionnaires about their intake of milk and dairy products, and about their physical activity. RESULTS: The mean+/-SD of the bone mineral density of the radial and ulnar distal diaphysis in the case group (0.430+/-0.038 g.cm(-2)) was significantly lower (p = 0.018) than that of the control group (0.458+/-0.039 g.cm(-2)). Likewise, the mean of the distal metaphysis of the forearm was 0.309+/-0.033 g.cm(-2) in the case group and 0.349+/-0.054 g.cm(-2) in the control group (p = 0.004). Milk intake (1.5+/-1.2 cups a day) was significantly lower in the case group (p = 0.001) than in the control group (2.7+/-1.2 cups a day). The number of boys who practiced after-school physical activity was significantly lower (p = 0.017) in the case group (six boys = 26%) than in the control group (15 boys = 53%). CONCLUSION: Boys who suffered forearm fracture showed lower bone mineral density compared with the control group. In the case group, milk intake and physical activity were lower than in the control group.

Trauma-induced changes in diaphyseal cross-sectional geometry in two elites from Copan, Honduras.

This research utilized biplanar radiographs to estimate cross-sectional biomechanical properties for the skeletal remains of two elite individuals from the Early Classic period (ca. AD 400-600) of Copan, Honduras: K'inich Yax K'uk' Mo' (Hunal Burial 95-2), founder of the Early Classic Dynasty at Copan, and the primary female interment (Burial 37-8) from the Motmot tomb. Both individuals survived severe blunt-force insults to the right forearm. Gross skeletal examination and evaluation of the radiographs for K'inich Yax K'uk' Mo' suggest that these traumas resulted from, at least in part, disuse atrophy of the affected forearm skeletal elements. Gross and radiologic evaluation of the Motmot remains countered the possibility that she suffered from a metabolic bone disease, and confirmed the presence of a well-healed parry fracture of the right ulna. The degree of asymmetry in cross-sectional biomechanical properties reported here for K'inich Yax K'uk' Mo' is likely the secondary result of the described blunt-force trauma. The results obtained for the principal Motmot interment are not as dramatic, but suggest subtle changes to humeral cross-sectional geometry subsequent to trauma.