Distal end radius fractures： evaluation of results of various treatments and assessment of treatment choice

Objective：The rapid expansion of knowledge regarding the functional anatomy of hand and wrist,increasing functional demands of senior citizens and improved methodologies of achieving and maintaining anatomic restoration of distal radius fractures has generated a renewed interest in addressing these fractures in a more precise manner.The purpose of our study was to evaluate the difference in patients function among those treated by 1） closed reduction and Plaster of Paris cast,2） distractor application,or 3） open reduction and internal fixation with a volar plate,and to assess the treatment choice for each particular fracture type.Methods：A prospective study was carried out on 60 patients with fractures of the distal end radius.Fractures were classified according to the AO classification into type A （extra-articular）,type B （partial articular） and type C （complete articular）.After initial evaluation patients were taken up for either conservative or operative treatment and were followed up for two years.Results：Anatomical results were evaluated according to the Sarmiento＇s modification of Lindstrom Criteria,which showed that excellent results were more frequent with open reduction and internal fixation using the plating technique.Clinical and functional results were evaluated according to the demerit point system of Gartland and Werley with Sarmiento modification,which was revealed to relate with the type of treatment techniques.Conclusion：There is no customized solution for all the fractures of the distal radius.The choice of treatment should be based on the fracture type,the patient＇s characteristics,the patient＇s demands and the treating surgeon＇s experience and preference.

Outcome of distal end clavicle fractures treated with locking plates

Purpose： Fractures of the lateral end of the clavicle are relatively uncommon. These fractures are unstable due to the various deforming forces which act on the fragments as well as the small distal fracture fragment. At most times the deforming forces are not taken into consideration, and the fracture is not fixed securely. In this study, we assessed a fixation technique using the precontoured locking plates to find out whether it provided a stable fixation with good functional outcome. Methods： Totally, 32 patients with lateral end clavicle fracture （Neer＇s Type ll） were included in the study. After the informed consent and preoperative investigations were obtained, open reduction and intemal fixation was done using a 3.5 mm precontoured superior locking plate with lateral extension under general anesthesia. Postoperative X-rays were done on day I and every 6 weeks after operation, until radiological union was achieved. The postoperative pain was assessed using Visual Analogue Scale （VAS） on postoperative days 1, 2 and 10. Postoperatively arm pouch sling was given for 2 weeks followed by active mobilization. Patients were asked to do their daily routine work and avoid lifting heavy weights. The functional outcome was assessed at the end of 2nd and 6th months with the help of Disabilities of the Arm, Shoulder and Hand （DASH} scoring. Results： There were no intraoperative complications in the procedure. The mean VAS score on post- operative day 1 was found to be 5 which decreased to 3 on day 2 and 0 on day 10. The mean DASH score was calculated as 11.63 at the end of postoperative month 2 and then 4.6 at the end of month 6. There was one case of malunion in whom the overhead abduction was restricted but was not painful and was managed conservatively. Conclusion： The precontoured locking plates with lateral extension may be a good method to fix the fractures of the lateral end clavicle, which provide a stable fixation with good functional outcome with very few instances of stiffness and decreased range of motion of the shoulder with the hook plates and failure of fixation in screw and K-wire fixations. It may well be the answer to the fixation questions of the lateral clavicle fractures, although larger comparative studies between the surgical treatment methods are required to confirm the same.

ARCH STRUCTURE OF TRABECULAE OF THE UPPER FEMORAL END AND ITS BIOMECHANICAL SIGNIFICANCE IN HIP FRACTURES

We studied ultrastructurally the cancellons bone tissues of the upper femoral ends, collected from 12 patients undergoing endoprostbesis replacement for fractures of the femoral neck and from 7 fresh cadavers. The bone tissues were composed of meshwork of trabeculae, that constituted tier upon tier of anisotropic arch structures of different diameters and sizes. The arch structures of the cancellous bone tissues in the femoral heads assumed round or roundish configurations, whereas those of the femoral head-neck junctions revealed oval outlines and those of the femoral necks showed narrow oval profiles. The fine structures of the trabecnlae in the femoral head could be divided into superficial zone, central zone, and transitional zone. Under weight-bearing, the central zone suited to sustain the load, while the superficial zone could produce elastic deformation lest fracture of the trabecaulae should ensue. The long axes of the oval arch structures of the femoral head-neck junction and the narrow oval arch structures of the femoral neck coincided with those of the femoral neck, thereby facilitating weight-bearing under physiological conditions. However, external violence in the form of either adduction or abduction force would act in a horizontal direction on the long axes of the oval and narrow oval arches so as to produce subcapital or transverse fracture of the femur in the aged.