Angular deformities and forearm function

Sarmiento, Augusto; Ebramzadeh, Edward; Brys, David A.; Tarr, Richard R.

doi:10.1002/jor.1100100115

Cited by 106 publications

(66 citation statements)

References 14 publications

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“…13,46,47 Up to 10° of angulation is associated with an acceptable limitation of rotation, and loss of 20° of forearm rotation is still compatible with good function. 48 It has been shown that anatomical alignment by operative intervention does not guarantee full return of movement. 32 In our study, all patients had angular deformities of less than 10° in both the AP and lateral radiographs.…”

Section: Discussionmentioning

confidence: 99%

Treatment of unstable fractures of the forearm in children

Bhaskar

Roberts

2001

The Journal of Bone and Joint Surgery. British volume

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U nstable fractures of the forearm in children present problems in management and in the indications for operative treatment. In children, unlike adults, the fractures nearly always unite, and up to 10° of angulation is usually considered to be acceptable. If surgical intervention is required the usual practice in the UK is to plate both bones as in an adult. We studied, retrospectively, 32 unstable fractures of the forearm in children treated by compression plating. Group A (20 children) had conventional plating of both forearm bones and group B (12 children) had plating of the ulna only. The mean age was 11 years in both groups and 23 (71%) of the fractures were in the midshaft. In group B an acceptable position of the radius was regarded as less than 10° of angulation in both anteroposterior (AP) and lateral planes, and with the bone ends hitched. This was achieved by closed means in all except two cases, which were therefore included in group A.Union was achieved in all patients, the mean time being 9.8 weeks in group A and 11.5 weeks in B. After a mean interval of at least 12 months, 14 children in group A and nine in group B had their fixation devices removed.We analysed the results after the initial operation in all 32 children. The 23 who had the plate removed were assessed at final review. The results were graded on the ability to undertake physical activities and an objective assessment of loss of rotation of the forearm.In group A, complications were noted in eight patients (40%) after fixation and in six (42%) in relation to removal of the radial plate. No complications occurred in group B.The final range of movement and radiological appearance were compared in the two groups. There was a greater loss of pronation than supination in both. There was, however, no limitation of function in any patient and no difference in the degree of rotational loss between the two groups. The mean radiological angulation in both was less than 10° in both AP and lateral views, which was consistent with satisfactory function. The final outcome for 23 patients was excellent or good in 12 of 14 (90%) in group A, despite the complications, and in eight of nine in group B (90%).If reduction and fixation of the fracture of the ulna alone restores acceptable alignment of the radius in unstable fractures of the forearm, operation on the radius can be avoided. Compression plating is widely accepted as the appropriate treatment for fractures of the forearm in adults in order to reduce the incidence of nonunion, malunion and subsequent loss of function.1-3 In children, a similar approach is usually unnecessary since healing of the fractures is rarely a problem and anatomical realignment is not required because of the remodelling potential of the immature skeleton. [4][5][6][7] The ability to remodel decreases with increasing age, and over ten years it is less predictable and less effective. [8][9][10] In children the correlation between malunion and function is poor, but residual angulation of more than 10° should probably be co...

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Section: Discussionmentioning

confidence: 99%

Treatment of unstable fractures of the forearm in children

Bhaskar

Roberts

2001

The Journal of Bone and Joint Surgery. British volume

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“…In our series of patients, there was evidence of a posttraumatic contracture of the interosseous membrane, because in numerous instances, the tension exerted by the interosseous membrane on the forearm bones did not permit correction of the bone deformity. Thus, release already was warranted to achieve the planned reduction after osteotomy as reported in experimental studies [24,33]. No clinical instability symptoms, statistically significant loss in grip strength, or occurrence of postoperative synostosis occurred in our patients after interosseous membrane release with respect to patients without membrane release.…”

Section: Discussionmentioning

confidence: 49%

“…Combined angular deformities of the radius and ulna in different directions reduce substantially more ROM than combined angulation in the same direction [37]. Proximal deformities had less impact on ROM than equivalent deformities produced at the middle or the distal third of the radius [33]. Similarly, several investigations assessed the effect of experimental axial malunions of the radius and ulna on pronation and supination [12,19,37,39].…”

Section: Discussionmentioning

confidence: 99%

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Correction of Forearm Malunion Guided by the Preoperative Complaint

Nagy

Jankauskas

Dumont

2008

Clinical Orthopaedics &Amp; Related Research

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“…5,6 Work by Sarmiento et al, 7 Matthews et al, 8 and Tarr, Garfinkel and Sarmiento 9 have shown that, except in very young children, residual angulation of the forearm greater than 10° should be corrected since remodelling is unpredictable. 10,11 Angulation has been shown to affect the range of pronation and supination of the forearm.…”

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confidence: 99%