Comminuted fractures of ipsilateral radial head and distal radius: A rare injury pattern

Wang, Yan; Wang, Luhong; Miao, Jianyun

doi:10.1016/j.cjtee.2015.07.002

Cited by 3 publications

(3 citation statements)

References 12 publications

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“…However, if reconstruction of the radial head is intended to be performed, either the proximal or distal radius can be fixed first. [ 30 ] Conversely, we believe that on-table construction of the radial head and its anatomic reattachment to the radial shaft might facilitate the anatomic reduction of difficult comminuted intra-articular distal radial fractures and help in the restoration of their radial length.…”

Section: Discussionmentioning

confidence: 99%

“…[5][6][7] A careful review of the literature reveals only six cases of concomitant ipsilateral comminuted distal radius and radial head fractures with fair to excellent outcomes. [7,[30][31][32][33] The details of the patient's demographics, injury mechanisms, related injuries, treatment options, and outcomes are shown in Table 1. Their treatments varied, with the radial head being replaced in four patients and internally fixed in the other two, while the distal radius fracture was internally fixed with a volar plate in five patients and an external fixator with bone grafting was applied in one case.…”

Section: Discussionmentioning

confidence: 99%

“…Most published case reports have addressed the distal radius first, followed by intervention on the radial head. [30][31][32] Such a sequence of interventions was recommended due to the restoration of radial length and Lister's tubercle, which are the major two landmarks used in determining the size and rotation of the radial head prosthesis. However, if reconstruction of the radial head is intended to be performed, either the proximal or distal radius can be fixed first.…”

Section: Simultaneous Fractures Of Both Radial Ends Are Uncommonmentioning

confidence: 99%

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Does simultaneous comminuted fracture of both radial ends represent a distinct fracture pattern?

Heydar

2024

Ulus Travma Acil Cerrahi Derg

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BACKGROUND: Although isolated distal radius and radial head fractures are common injuries, simultaneous ipsilateral fractures are uncommon. They can range from simple undisplaced fractures at either end to severely comminuted ipsilateral proximal and distal radial fractures. Few cases have been reported with concomitant comminuted distal radius and radial head fractures, and no treatment guidelines are available. Decisions are often based on personal recommendations. The purpose of our study is to increase awareness of this injury pattern and to discuss the mechanism of injury, treatment approach, and functional outcome. METHODS: Skeletally mature patients with comminuted simultaneous ipsilateral fractures of the distal and proximal radius from 2016 to 2021 were identified and studied retrospectively. Demographic information, mechanism of injury, treatment approach, and complication rate were analyzed. Radiographic assessment for inadequacy or loss of reduction and radiographic parameters of the distal radius, including radial inclination, radial length, and palmar inclination, was performed immediately postoperatively and at the final follow-up. Clinical outcomes were determined by calculating the Visual Analog Scale (VAS) score, measuring the range of motion in both joints, and using the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score at the final follow-up. RESULTS: A total of 11 patients met the inclusion criteria. All had ipsilateral Mason III radial head fractures and type C (according to the Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification) intra-articular distal radius fracture. On-table radial head reconstruction and fixation with a proximal radius plate were used for radial head fractures, and osteosynthesis with an anatomic volar locking plate was used for distal radius fractures. The mean follow-up duration was 32 months (range 12-65 months). At the final follow-up, osseous union of both the radial head and distal radius was observed in all patients. The mean VAS score was 1.5 (range 0-7) at rest and 3.9 (range 0-9) with activities, while the mean QuickDASH score was 32 (range 12-65). No significant complications were recorded. CONCLUSION: Simultaneous comminuted fractures of the ipsilateral distal radius and radial head represent a distinct injury pattern, most likely resulting from high-energy trauma, such as falling from a height onto an outstretched hand. Greater emphasis should be placed on clinical examination and radiological imaging of the elbow in cases of wrist injuries and vice versa. Treatment involving on-table reconstruction of the radial head and open reduction and internal fixation with a volar plate can lead to good radiological and functional outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Simultaneous Fractures Of Both Radial Ends Are Uncommonmentioning

confidence: 99%

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Does simultaneous comminuted fracture of both radial ends represent a distinct fracture pattern?

Heydar

2024

Ulus Travma Acil Cerrahi Derg

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Simultaneous ipsilateral distal radius and radial head fractures

et al. 2021

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Rationale: Distal radius fracture with simultaneous ipsilateral radial head fracture is a very rare pattern of injury. This type of injury is referred to as ‘radius bipolar fracture’. Treatments for this injury pattern can be challenging because both the wrist and elbow need to be considered. There are currently no guidelines for the treatment of this specific type of injury. We report two cases of this unusual pattern of injury treated in our hospital. Patient concerns: Case 1 was a 78-year-old female patient and case 2 was a 19-year-old female patient who visited our emergency department with left elbow and wrist pain after slipping and falling. Diagnosis: Plain radiography and computed tomography revealed radius bipolar fracture. Case 1 had an AO type C3 distal radius fracture, a Mason type III radial head fracture. Case 2 had an AO type B2 undisplaced distal radius fracture and a Mason type III radial head fracture. Interventions: In case 1, open reduction and internal fixation (ORIF) was performed for the distal radius fracture and radial head replacement arthroplasty for the radial head fracture. In case 2, distal radius fracture was treated conservatively and ORIF was performed for the radial head fracture. Outcomes: Bony union as achieved in both cases. At 1-year follow-up, case 1 showed slight limited range of motion of the wrist. Case 2 showed no radius shortening and full range of motion of the wrist and elbow. The Quick disabilities of the arm, shoulder and hand score was 18 and 16, respectively. Lessons: After this type of injury, the radius length can be changed, and as a result, ulnar variance can be affected. When radial head replaced is considered, it would be better to operate on the wrist first, and then perform radial head replacement. In this way, radiocapitellar overstuffing or instability can be prevented. However, if ORIF is planned for proximal radius fracture, either the proximal or distal radius can be fixed first. Surgeons should try to preserve radial length during treatment to optimize patient outcomes.

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Concurrent Proximal Fractures Are Rare in Distal Forearm Fractures: A National Cross-sectional Study

Negaard

Vakkalanka

Whipple

et al. 2019

WestJEM

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IntroductionDistal forearm fractures (DFF) account for 1.5% of emergency department (ED) visits in the United States. Clinicians frequently obtain imaging above/below the location of injury to rule out additional injuries. We sought to determine the incidence of associated proximal fractures (APF) in the setting of DFF and to evaluate the imaging practices in a nationally representative sample of EDs.MethodsWe queried the 2013 National Emergency Department Sample using International Classification of Diseases, 9th edition, diagnostic codes for DFF and APF. Current Procedural Technology codes identified associated imaging studies. We calculated national estimates using a weighted analysis of patient and hospital-level characteristics associated with APF and imaging practices. An analysis of costs estimated the financial impact of additional imaging in patients with DFF using Medicare reimbursement to approximate costs according to the 2018 Medicare Physician Fee Schedule.ResultsIn 2013, an estimated 297,755 ED visits (weighted) were associated with a DFF, of which 1.6% (4836 cases) had an APF. The incidence of APF was lower among females (odds ratio [OR] (0.76); 95% confidence interval [CI], 0.64–0.91) but higher in metropolitan teaching hospitals compared to metropolitan non-teaching hospitals (OR [2.39]; 95% CI, 1.43–3.99) and Level 1 trauma centers (OR [3.9]; 95%, 1.91–7.96) compared to non-trauma centers. Approximately 40% (n = 117,948) of those with only DFF received non-wrist radiographs and 19% (n = 55,236) underwent non-wrist/non-forearm imaging. Factors independently associated with additional imaging included gender, payer, patient and hospital rurality, hospital region, teaching status, ownership, and trauma center level. Nearly $3.6 million (2018 U.S. dollars) was spent on the aforementioned additional imaging.ConclusionDespite the frequency of proximal imaging in patients with DFF, the incidence of APF was low. Further study to identify risk factors for APF based on mechanism and physical examination factors may result in reduced imaging and decreased avoidable healthcare spending.

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Comminuted fractures of ipsilateral radial head and distal radius: A rare injury pattern

Cited by 3 publications

References 12 publications

Does simultaneous comminuted fracture of both radial ends represent a distinct fracture pattern?

Does simultaneous comminuted fracture of both radial ends represent a distinct fracture pattern?

Simultaneous ipsilateral distal radius and radial head fractures

Concurrent Proximal Fractures Are Rare in Distal Forearm Fractures: A National Cross-sectional Study

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