Articles: ulna-fractures-therapy.
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Acta Chir Orthop Traumatol Cech · Jan 2015
[Conservative and Surgical Treatment for Distal Ulna Fractures Associated with Distal Radius Fractures].
Fractures of the distal radius and distal ulna require anatomical reconstruction for good restoration of wrist and hand function. In this study we compared the results of conservative treatment with those of plate osteosynthesis management in distal ulna fractures of patients who had concomitant fractures of the distal radius indicated for plate osteosynthesis. Our objective was to specify indications for plate osteosynthesis of a distal ulna fracture in the case of an associated distal radius fracture. ⋯ Views vary on whether the distal ulna should be treated by plate osteosynthesis when, after distal radius fixation, its fracture managed by closed reduction heals well. A distal ulna plate often causes pain and has to be removed. The acute cases of DRUJ instability caused by comminuted distal ulna fracture can be treated by osteosynthesis of the distal ulna and two Kirschner wires inserted into the fracture site in an ulnar-to-radial direction. For chronic radioulnar instability, various methods involving free tendon grafts and dynamic tenodesis are used. Other options include the Sauvé-Kapandji procedure based on inducing artificial non-union of the distal ulna diaphysis and radioulnar arthrodesis; in our modification of this technique we use a single cancellous malleolar screw. In severely comminuted fractures of the distal ulna with injury to articular cartilage, ulnar head replacement can be indicated. CONCLUSIONS Distal ulna fractures can be treated conservatively if osteosynthesis of the distal radius in the anatomical position is achieved together with anatomical reduction of bone fragments of the distal ulna. When a distal radius fracture managed by osteosynthesis is not accompanied by anatomical reduction of distal ulna fragments, or the ulna is shorter or longer than the contralateral bone, an open reduction and stabilisation using an angle-stable locking plate, set at an adequate radius-toulna length ratio, is the method of choice.
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Randomized Controlled Trial
Outcomes of long-arm casting versus double-sugar-tong splinting of acute pediatric distal forearm fractures.
The traditional treatment after closed reduction of distal radius (DR) and distal both bone (DBB) forearm fractures has been application of a long-arm cast (LAC) or a short-arm cast (SAC). Splinting is another option that avoids the potential complications associated with casting. The purpose of this study is to evaluate the maintenance of reduction of DR or DBB fractures placed in a double-sugar-tong splint (DSTS) compared with a LAC in a pediatric population. ⋯ Level II-prospective, comparative study.
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The distal forearm fracture is the most common injury (40%) in pediatric traumatology. ⋯ Treatment of distal forearm fractures should be appropriate for children as well as highly efficient, by using a minimal amount of effort. Current forms of overtreatment have to be avoided because of moral and in particular economic reasons.
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Randomized Controlled Trial
Forearm fractures in children: split opinions about splitting the cast.
Fractures of the forearm are the most common fractures in children. Various methods of cast immobilization have been recommended. Currently, there is still controversy regarding the optimal method of treatment, especially regarding the need for cast splitting. ⋯ No significant difference in the incidence of cast-related problems was observed between the groups. Fracture stability was comparable in both groups. We suggest that closed circumferential semirigid casts are a safe and effective immobilization technique for fractures of the forearm in children and splitting can be omitted.
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Forearm fractures occur commonly in children; however, there is still uncertainty on what leads to conversion from conservative to operative management. Patients who initially underwent closed reduction and casting for diaphyseal forearm fractures were evaluated for predictors of conversion to operative management. We found that the 20 of 124 (16%) patients in whom there was conversion to operative management were significantly older (11.1 vs. 5.7 nonoperative), had less angulation in the anterior-posterior (or coronal) plane (20.2 vs. 12.8° for the radius, 17.5 vs. 7.8° for the ulna), had a more proximal ulnar fracture location, and had more translated or shortened radius fractures.