Forearm fractures. Early functional bracing - A preliminary report

Sarmiento, Augusto; Cooper, JS; Sinclair, WF

doi:10.2106/00004623-197557030-00002

Cited by 76 publications

(23 citation statements)

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“…The same principles of soft tissue control of the fragments have been applied to several different areas of the body for 10. Load-deflection graph of a limb under laboratory conditions indicating the stiffness of the limb prior to fracture and the loss of stiffness after fracture before a fracture brace is applied.…”

Section: Stability O F Fracturesmentioning

confidence: 99%

The Rationale of Functional Bracing of Fractures

Latta¹,

Sarmiento

Tarr

1980

Clinical Orthopaedics and Related Research

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Fracture bracing is a philosophy rather than merely the use of orthotic devices in the treatment of fractures. It is predicated on the belief that immobilization of the fragments and the joints above and below the fracture is not necessary for fracture healing. It proposes also that the soft tissues of the injured extremity play a major role in providing the stability necessary to allow uninterrupted osteogenesis.The encouraged early function, weightbearing and motion of the joints and fracture fragments during treatment challenges the basic concepts of surgical as well as nonsurgical fracture management which emphasize that rest and fragment immobilization are prerequisites for fracture healing. In an effort to elucidate these conflicts and gain a better understanding of how bracing works, a series of laboratory studies was c~n d u c t e d .~~~~~~~~This article provides a synopsis of the important portions of this research as they apply to fracture bracing. VASCULARITY AND FRACTURE HEALINGAt the time of a diaphyseal fracture, the normal blood supply to the bone is disrupted and a hematoma forms at the fracture site. Medullary circulation is almost always disrupted and is slow to re-establish. Subsequently, capillaries invade the area of the fracture site from the peripheral soft tissues. The importance of the early revascularization from soft tissues is emphasized by the close association of early bone formation with vascular invasion (Fig. 1). A possible explanation for the new bone formation following the capillary invasion was offered by Trueta, who suspected endothelial metap1a~ia.I~ Much of our work has supported this theory by demonstrating the close proximity of osteoblastic and osteoclastic activity to the invading vasculature (Fig. 2 ) .Thus, one important role of function in fracture healing can well be the early vascular invasion stimulated by muscle activity. When function is introduced early in this nonsurgical management regimen, the activity level of the osteoblasts and osteoclasts is high as indicated by light and electron microscopy (Fig. 3). FRACTURE CALLUS ARCHITECTUREThe importance of the gross architecture of callus formation when healing takes place in the presence of function and muscle activity is based upon the structural role of bone. The callus architecture forms in the following manner: initially, a hematoma surrounds the area near the fracture site and the bone ends and loose fragments become necrotic. Away from the fracture site early revascularization comes from medullary circulation. The callus formation at this point is of intramembranous origin, therefore 0009-921X/80/0100/028 $00.95 0 J . B. Lippincott Co. 28

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Section: Stability O F Fracturesmentioning

confidence: 99%

The Rationale of Functional Bracing of Fractures

Latta¹,

Sarmiento

Tarr

1980

Clinical Orthopaedics and Related Research

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“…4 Malunion and nonunion occur more frequently because of difficulty in reducing and maintaining reduction of two parallel bones in the presence of the pronating and supinating muscles that have angulatory as well as rotational influences. 50,52 Because of these factors surgical management for displaced diaphyseal fractures in the adult is generally accepted.…”

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confidence: 99%

Study of Different Modalities of Surgical Treatment of Diaphy Seal Fractures of Forearm in Adults

Kumar¹

2015

jemds

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BACKGROUNDS AND OBJECTIVES: Sixty cases of fracture both bone forearm in adults were operated and fixed using various instruments in Narayana Medical College and Hospital, Nellore. The study period was June 2009 to June 2013. The case were followed up from four months to ten months. METHODS: Most of the cases were young adult male with age ranging between 17 to 73 years. The functional outcome of different modalities of surgical treatment of diaphyseal fracture of both bone forearm in adults are interpreted. We have fixed 17 patients with Dcp, 13 patients with Lcdcp, 14patients with Semitubular plating and 16 patients with Intramedullary nailing. Most cases were operated within three days of injury. Anaesthesia and Tourniquet was used for all cases. Thompsons approach was used for proximal radial fractures and Henrys approach was used for distal radial fractures. Ulna was exposed along its posterior border. Intramedullary nailing was done along radial syloid process and distal tip of olecranon in radius and ulna respectively. Closed reduction under C-arm in intramedullary procedure and open reduction and internal fixation when plating was done. Above elbow p.o.p slab were applied for all operated case. Sutures were removed at 10 th Post-operative day. Mobilization were started after suture removal in plating cases. In Intramedullary nailing cases mobilization started after clinical and radiological union. RESULTS: By Anderson Scoring System out of 14 cases of Dcp 75 %were excellent, 25% were satisfactory. Out of 11cases of Lcdcp 72.7% were excellent, 18.2% were satisfactory, 9.1% were unsatisfactory. Out of 13cases of Semitubular plating 69.2%were excellent, 23.1% were satisfactory, 7.7% were unsatisfactory. Out of 14 cases of Intramedullary nailing with Talwakar square nails 42.9% were excellent, 21.4% were satisfactory, 21.4% were unsatisfactory, 14.3%had failure results. INTERPRETATION AND CONCLUSION: Open reduction and internal fixation can be considered as the treatment of choice if there were no contraindications for this because it is important to maintain length, opposition, axial alignment and rotation alignment if a good range of movement of forearm is to be restored. This is achieved in the present study.

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“…To avoid radioulnar instability, it is recommended that the shortening of the ulna stump should not exceed 35 mm proximal to the DRUJ [136]. When postoperative dynamic radioulnar instability occurs, then an individually customized thermoplastic functional forearm brace, formerly introduced by Sarmiento et al for the non-operative treatment of forearm fractures, is able to reduce postoperative discomfort such as in our presented patient's case [137,138].…”

Section: Discussionmentioning

confidence: 87%

Who introduced the "quadrangular-construct" modification of the Sauvé Kapandji procedure first? Case presentation and brief overview of literature with regard to general, specific and practicable aspects to primary trauma-related surgical treatment including possible salvage options at the distal radioulnar joint

Schmidt¹,

Schmitz²,

Muradyan³

et al. 2017

Trauma Emerg Care

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A 26-year-old male sustained a left wrist injury after an occupational fall from height that was diagnosed as wrist sprain and treated conservatively by a plaster splint in another institution. Eight weeks after injury, the patient could be re-employed in his original occupation as a truck driver. Six years after injury, the patient came in our institution for the first time, and reported increasing pain in his left wrist accompanied with marked restriction of his left forearm's supination and pronation leading to the non-ability to carry out his occupational job 8 weeks previously. On clinical examination, there was pronounced dorsal subluxation of the ulnar head without any given possibilities for it manual closed reduction (i.e. static instability in transverse plane) ( Figure 1A). Posterior-anterior (PA) radiographs of both wrists showed no concomitant ulnar positiv variance (UPV) (i.e. no longitudinal instability) and no posttraumatic arthritic changes in the distal radioulnar joint (DRUJ), but the configuration of the ulnar styloid at the formerly injured left wrist could not be well assessed that suggested an additional rotation deformity of the ulnar head ( Figure 1B). Lateral radiographs of both wrist showed marked fixed subluxation of the ulnar head in dorsal direction (i.e. static instability in transverse plane) ( Figure 1C). Due to these findings, the Sauvé-Kapandji procedure, modified by creating a "quadrangularconstruct", was detected by us. At the preoperative radiographs of the left elbow in both planes there were no signs of any pre-existing degenerative changes with specific regard to the radiocapitellar joint.Intraoperatively, first, the 2 cm long ulna segment was excised typically proximal to the DRUJ, then a Kirschner-wire was drilled into the ulnar head parallel to the plane of the operation table on which the left forearm was positioned at terminal range of pronation (i.e. 90°) ( Figure 2A). After that, the ulnar head was rotated 90° perpendicular to the operation table's plane in dorsal direction using the formerly drilled Kirschner-wire, and so the neutral position of DRUJ could be achieved in which the arthrodesis had to be performed ( Figure 2B). Then, the cartilage of both corresponding surfaces in DRUJ was excised, and the DRUJ arthrodesis in neutral position was carried out using a 3.5 mm titanium malleolar screw, and the Kirschner-wire was removed. The next step included the several years later introduced "quadrangularconstruct" modification of the original Sauvé-Kapandji procedure: After decorticalization of the corresponding radius and ulna shafts proximal to the DRUJ arthrodesis and distal to resection plane of the ulna segment, the formerly excised ulna segment has been inserted transversely between both forearm bones and fixated with a second 3.5 mm titanium cortical screw through the ulna segment graft, and finally, complete restoration of rotation motion arc could be achieved ( Figures 2C-D). The correctly performed surgical procedure was confirmed intraoperatively by flu...

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Forearm fractures. Early functional bracing - A preliminary report

Cited by 76 publications

References 0 publications

The Rationale of Functional Bracing of Fractures

The Rationale of Functional Bracing of Fractures

Study of Different Modalities of Surgical Treatment of Diaphy Seal Fractures of Forearm in Adults

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