Journal of Musculoskeletal Trauma

Epiphyseal Fractures of the Distal Radius in the Children: Hui Taek Kim, Myung Soo Youn, Jong Seo Lee, Young Jun Choi, Yoon Jae Seong; J Korean Fract Soc 2008;21(3):225-231. Published online July 31, 2008; DOI: https://doi.org/10.12671/jkfs.2008.21.3.225

PURPOSE
To evaluate the long-term results of treatment of epiphyseal fractures of the distal radius in children.
MATERIALS AND METHODS
23 cases of distal radial epiphyseal fracture, treated by two methods: group 1, closed reduction (CR) plus cast (6 cases); group 2, CR and K-wire fixation (under anesthesia due to marked translation of the distal fragment and swelling) plus cast (17 cases), were selected for this study. All patients were followed up for more than 1 year (average: 3.2 years). Postoperatively, epiphyseal displacement and epiphyseal angulation were measured on anteroposterior and lateral radiographs. At follow-up, the affected and normal sides were compared. Final results were classified by radiologic (radial inclination, volar tilting and radial shortening) and clinical (limitation of ROM, wrist pain, grip strength and wrist deformity) criteria.
RESULTS
Group 1 had 5 good, 1 fair result; group 2 had 14 good, 2 fair and 1 poor - there was no statistically significant difference between two groups. All cases where the epiphyseal displacement was less than 30% had good results. A poor case showed a radial shortening, wrist deformity and pain due to premature epiphyseal closure. Premature epiphyseal closure was treated by bar resection and free fat, along with corrective osteotomy when necessary and lengthening of radius with or without epiphysiodesis of the ulna.
CONCLUSION
Remodeling can be expected in epiphyseal fractures of the distal radius. Repeated forceful attempts to achieve accurate reduction should be avoided to prevent secondary physeal injury.

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How long does it to achieve sagittal realignment of the displaced epiphysis in Salter-Harris type II distal radial fracture when treated by manual reduction?
Seung Hoo Lee, Hyun Dae Shin, Eun-Seok Choi, Soo Min Cha
Journal of Plastic Surgery and Hand Surgery.2023; 57(1-6): 346. CrossRef

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Surgical treatment using external fixator for unstable intra-articular fracture of distal radius: Chul Hong Kim, Byeong Hwan Kim, Sung Won Lee, Wook Kim; J Korean Soc Fract 2003;16(1):83-90. Published online January 31, 2003; DOI: https://doi.org/10.12671/jksf.2003.16.1.83

Abstract PDF: PURPOSE
To analyze the results of surgical treatment using external fixator for unstable intra-articular fracture of distal radius. MATERIAL AND METHODS: We investigated 38 cases of distal radius fracture from Mar. 1990 to Dec. 2000. The patients were followed up for average 18 months postoperatively. We compared the results of 22 cases, treated with open reduction and internal fixation(ORIF) to the results of 16 cases, treated with ORIF and external fixation. We evaluated the results of the mean loss of radial length, radial inclination, volar tilt and traumatic arthritis according to demerit point rating system above the Fernandez classification IV.
RESULTS
According to demerit point rating system, excellent to good results were obtained in 72.7% at ORIF and external fixator, compared to 43.8% at case of ORIF only. In the last follow up, the mean loss of radial length was 0.6mm in case of ORIF, but 0.4 mm in case of ORIF and external fixator, the mean loss of radial inclination was 2.3 and 1.5 degrees, the mean loss of volar tilt was 2.5 and 2.2 degrees, respectively (p < 0.05). Postoperative complications were developed in 9 cases. Malunion was in 4 cases of ORIF and external fixator, in 2 cases of ORIF. Metacarpal bone fracture was in 1 case of ORIF and external fixation. Traumatic arthritis was in 2 cases of ORIF.
CONCLUSION
Open reduction and internal fixation combined with external fixation was thought to be a better method than open reduction and internal fixation for the treatment of unstable intra-articular fractures of the distal radius of the Fernandez classification IV and IV, because that was more comfortable and convenient to patients and was useful to prevent late displacement.

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Intraarticular Soft Tissue Injuries in Fractures of the Distal Radius: A Descriptive Arthroscopic Study: Seok Beom Lee, Chang Beom Lee; J Korean Soc Fract 2001;14(4):726-732. Published online October 31, 2001; DOI: https://doi.org/10.12671/jksf.2001.14.4.726

Abstract PDF

PURPOSE
The aim of this study was to determine prevalence of the associated intraarticular soft tissue lesions with fractures of the distal radius by arthroscopic evaluation of the wrist joint and thus to avoid poor outcome after the conventional treatment. MATERIAL AND METHOD: Medical records, radiographs and arthroscopic findings of 27 patients with fractures of the distal radius that underwent arthroscopic procedures were reviewed . Relationships between fracture pattern and associated lesions of the triangular fibrocartilage complex (TFCC), scapholunate and lunotriquetral ligaments were investigated.
RESULTS
71% of fractures of the distal radius were associated with soft tissue lesions. Among those, tear of the triangular fibrocartilage complex was the most prevalent (47%). Associated lesions such as TFCC, scapholaunate and lunotriquetral lesion were more common with inraarticular fracture, while severe nature of the lesion that neccessiated pinning and/or arthroscopic repair was more common with extraarticular fractures of the distal radius.
CONCLUSION
Incidence of the associated soft tissue lesions in this study were comparably high with the latest publications. The authors suggest strongly that wrist arthroscopy should accompay any procedure for fractures of the distal radius, if it is to be done under anesthetic control, to get more favorable outcome.

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Arthroscopic Repair for Traumatic Peripheral Tear of Triangular Fibrocartilage Complex
Seung-Ju Jeon, Chan-Sam Moon, Ho-Seung Jeon, Haeng-Kee Noh, Sung-Hwan Kim
Journal of the Korean Fracture Society.2007; 20(4): 330. CrossRef

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Non-operative Treatment of Fracture of Distal Radius in Adults: Sang Won Park, Ki Hoon Kang, Ki Hong Lee; J Korean Soc Fract 1999;12(1):153-161. Published online January 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.1.153

Abstract PDF: The authors analysed ninety-five cases of fracture of distal radius in adults with non-operative treatment followed for more than one year at Korea University Hospital from January 1991 to December 1996 to evaluate the clinical results according to the types of fracture by Fernandez classification and the methods of non-operative treatment. The results obtained were as follows ; 1. Methods of treatment were closed reduction and cast immobilization in 51 cases(53.7%) and closed reduction and percutaneous pinning in 44 cases(46.3%). 2. In a group treated with closed reduction and cast immobilization, the results of subjective evaluation were excellent in 3.9%, good in 47.1%, fair in 45.1% and poor in 3.9%, and the results of objective evaluation were good in 42.8%, fair in 36.5%, and poor in 20.7%. 3. In a group treated with closed reduction and percutaneous pinning, the results of subjective evaluation were excellent in 6.8%, good in 54.5%, fair in 29.5% and poor in 9.2%, and the results of objective evaluation were excellent in 15%, good in 46.6%, fair in 35%, and poor in 3.4%. 4. The results of subjective evaluation according to fracture type were excellent and good in 91.3% of type I, 42.1% of type II, and 10% of type III, and the results of objective evaluation were excellent and good in 78.3% of type I, 52.6% of type II, and 3.5% of type III. 5. The results of subjective and objective evaluation were not satisfactory in patients older than seventy years old. Above results suggest that the clinical results of non-operative treatment were not satisfactory in type III, therefore external fixation or operative treatment is recommended.

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Non-operative Treatment of Fracture of Distal Radius in Adults: Sang Won Park, Ki Hoon Kang, Ki Hong Lee; J Korean Soc Fract 1999;12(1):145-152. Published online January 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.1.145

Abstract PDF: The authors analysed ninety-five cases of fracture of distal radius in adults with non-operative treatment followed for more than one year at Korea University Hospital from January 1991 to December 1996 to evaluate the clinical results according to the types of fracture by Fernandez classification and the methods of non-operative treatment. The results obtained were as follows ; 1. Methods of treatment were closed reduction and cast immobilization in 51 cases(53.7%) and closed reduction and percutaneous pinning in 44 cases(46.3%). 2. In a group treated with closed reduction and cast immobilization, the results of subjective evaluation were excellent in 3.9%, good in 47.1%, fair in 45.1% and poor in 3.9%, and the results of objective evaluation were good in 42.8%, fair in 36.5%, and poor in 20.7%. 3. In a group treated with closed reduction and percutaneous pinning, the results of subjective evaluation were excellent in 6.8%, good in 54.5%, fair in 29.5% and poor in 9.2%, and the results of objective evaluation were excellent in 15%, good in 46.6%, fair in 35%, and poor in 3.4%. 4. The results of subjective evaluation according to fracture type were excellent and good in 91.3% of type I, 42.1% of type II, and 10% of type III, and the results of objective evaluation were excellent and good in 78.3% of type I, 52.6% of type II, and 3.5% of type III. 5. The results of subjective and objective evaluation were not satisfactory in patients older than seventy years old. Above results suggest that the clinical results of non-operative treatment were not satisfactory in type III, therefore external fixation or operative treatment is recommended.

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