D Stoffelen

The importance of the distal radioulnar joint in distal radial fractures

In a prospective study we evaluated the results of 272 distal radial fractures by their involvement of the distal radioulnar joint. Impaired function following altered anatomy at the distal radius can be explained by dysfunction of the distal radioulnar joint. Ulnar styloid avulsions contribute to a poorer result because of their effect on distal radioulnar joint function.

Closed reduction versus Kapandji-pinning for extra-articular distal radial fractures

In a randomized prospective trial, treatment of extra-articular distal radial fractures by closed reduction and plaster application was compared with Kapandji-pinning. Closed reduction and plaster cast was used in 50 patients, Kapandji-pinning in 48 patients. According to the Cooney score, good and excellent results were found in the closed reduction and plaster cast group in 74%, compared with 75% in the Kapandji-pinning group. After measuring the maintenance of reduction as well as the functional outcome at 1 year follow-up, no statistically significant differences could be found between the two groups. We conclude that both techniques can be used in treating extra-articular fractures of the distal radius.

The Clinical Importance of Carpal Instabilities Following Distal Radial Fractures

A prospective study was undertaken to determine the clinical importance of the different carpal instabilities following dorsally displaced distal radial fractures (Colles’ type). All patients were followed for 1 year and a Cooney score and X-ray evaluation were done. Nine different carpal instabilities were evaluated. Only dissociative DISI and ulnar translocation showed significant clinical differences at 1 year follow-up. It is therefore recommended that a dissociative DISI, usually caused by scapholunate dissociation, should be treated by percutaneous pinning at the time of the initial treatment.

Incidence of cartilaginous and ligamentous lesions of the radio-carpal and distal radio-ulnar joint in an elderly population

51 wrists of 30 embalmed cadavers have been used to perform an anatomical and radiological study relating cartilaginous and ligamentous lesions of the wrist with sex, age, ulnar variance (UV) and the state of the triangular fibrocartilage complex (TFCC) in an elderly population (mean 76.6 years). Two-thirds of all wrists (66%) showed cartilaginous lesions, mainly on the lunate (22, or 44%). The TFCC was perforated in 23 wrists (46%), and most were central degenerative perforations. Correlations were found between ulnar variance and TFCC thickness (P<0.05) and ulnar variance and TFCC perforations (P<0.05). A significant relation was observed between age and proximal row intercarpal ligamentous ruptures (P<0.05) and between age and ulnar variance (P<0.05). No statistical correlation was seen between ulnar variance and cartilaginous lesions on the lunate (P<0.05) in this slightly ulnar negative population (mean–0.37 mm).

Minimally displaced distal radius fractures: do they need plaster treatment?

In a prospective, randomized trial, minimally displaced distal radius fractures were divided into two groups: those treated with plaster immobilization for 1 week compared with 3 weeks. Functional Cooney scores were determined at 6 weeks, 3 months, 6 months, and 1 year. No statistical differences could be found in functional outcome between the groups at any time during the evaluation. Although patients did not allow immediate functional treatment in the presence of a fracture, we could not find any differences between 1 week or 3 weeks of plaster treatment. No further dislocation occurred, and all patients experienced eventful healing with good and excellent results in 92% of the cases. We believe, therefore, that only minimal immobilization is required in these fractures and that they should be mobilized as soon as comfort allows.

Die operative Versorgung der vollständigen akromioklavikularen Luxation Tossy III mit der Bosworth-Schraube oder Wolter-Platte. Eine kritische Betrachtung

Die Autoren best~itigen die seit Jahren kontrovers geffihrte Diskussion fiber die Indikation zur operativen Behandlung der kompletten Luxation des Schultereckgelenks, die trotz einer Vielfalt operativer Verfahren und Implantate hfiufig keine signifikant besseren Ergebnisse im Vergleich zur konservativen Behandlung erzielen. Allerdings haben die von Broos et al. verwendeten Implantate Wolter-Platte und Bosworth-Schraube einen charakteristischen Nachteil: Beide Implantate stabilisieren zwar das Akromioklavikulargelenk, schr~inken aber auch die Rotationsbewegungen der Klavikula so stark ein, dab Imptantatlockerungen oder brtiehe und h~iufig posttraumatische Arthrosen des Akromioktavikulargelenks zu erwarten sind, zumal eine komplette Ruhigstellung des Schultergfirtels bekanntlich nicht m0glich ist. Die Balser-Platte und die Akromioklavikulargelenkplatte nach Rhamanzadeh oder das korakoklavikulfire Banding mit resorbierbarem Nahtmaterial stabilisieren zwar ebenfalls das Akromioklavikulargelenk, lassen der Klavikula aber einen gewissen Spielraum ohne Gef~ihrdung der Gelenkstabilit~it. Mit diesen Verfahren, die ausffihrtich in dem von Rhamanzadeh u. Meissner herausgegebenen Referateband der 1t. Steglitzer Unfalltagung (Unfallund Wiederherstellungschirurgie des Schultergtirtels. Springer, Berlin-Heidelberg-New York 1993) beschrieben sind, wurden auf der Basis des Stappaerts-Scores in 86 his 90% sehr gute und gute Ergebnisse erzielt, insbesondere GelenkstabilitSt und schmerzfreie Beweglichkeit. Verkalkungen der Bfinder und ein geringes H6hertreten der Klavikula um weniger als halbe Schaftbreite unter Belastung sind ohne Bedeutung und werden sowohl nach konservativer als auch operativer Behandtung nachgewiesen.