• MeSH
• Child MeSH
• Humans MeSH
• Radius surgery   injuries   MeSH
• Epiphyses, Slipped surgery   therapy   MeSH
• Therapeutics methods   MeSH
• Check Tag
• Child MeSH
• Humans MeSH

• MeSH
• Adult MeSH
• Radius Fractures surgery   MeSH
• Internal Fixators MeSH
• Bone Plates MeSH
• Bone Screws MeSH
• Humans MeSH
• Bone Regeneration MeSH
• Fracture Fixation, Internal methods   MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Male MeSH
• Female MeSH

Autoři ve svém sdělení prezentují zkušenosti s léčbou poranění proximálního radia u dětí. V období 1994-1998 léčili celkem 59 pacientů, z toho postupovali lOx otevřenou metodou, 15x perkutánní fixací a 34x konzervativně. Srovnávají výsledky léčby obou operačních metod, kde prokazují lepší výsledky u mininvazivního přístupu - perkutánní fixace. Autoři doporučují tento postup při dislokovaných poraněních II. a III. typu a zdůrazňují nutnost kvalitního technického vybavení a zkušeností pracoviště.

The authors present their experience with treatment of injuries of the proximal radius in children. During the period between 1994 and 1998 they treated on account of this injury a total of 59 patients. Ten times they used the open method, 15 times percutaneous fixation and 34 times a conservative approach. They compare the therapeutic results of both surgical methods and demonstrate better results when the miniinvasive approach percutaneous fixation - is used. The authors recommend this procedure in dislocated injuries type II and III and emphasize the necessity of high standard technical equipment and experience of the working team.

• MeSH
• Child MeSH
• Radius Fractures etiology   surgery   MeSH
• Humans MeSH
• Minimally Invasive Surgical Procedures methods   MeSH
• Fracture Fixation, Internal methods   MeSH
• Check Tag
• Child MeSH
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Review MeSH

Autoři sledovali dlouhodobě základní epidemiologické charakteristiky u zlomenin proximálního humeru (1464 pacientů), distálního radia (2514 pacientů), proximálního femuru (3340 pacientů) a luxačních zlomenin hlezna (1195 pacientů). U zlomenin proximálního femuru byl celkový průměrný věk 78 roků, průměrný věk mužů 71, 6 roků a u žen 80,3 roku, poměr muži/ženy byl 27:73. U zlomenin proximálního humeru byl celkový průměrný věk 67 roků, u mužů 58,8 roků, u žen 71,2 roku a poměr muži/ženy činil 30:70. U zlomenin distálního radia byl celkový průměrný věk 59 roků, průměrný věk mužů 45,8 roků a žen 64,7 roků, poměr muži/ženy činil 29:71. Luxačních zlomenin hlezna byl průměrný věk 49 roků, průměrný věk mužů 43,4 roků a žen 54,7 roků, poměr muži/ženy činil 50:50. Do konce 5. dekády bylo u všech zlomenin vyšší zastoupení mužů, od 6. dekády se poměr obrátil. Zavedení nových implantátů (úhlově stabilní dlahy, nová generace hřebů) pro zlomeniny distálního radia a proximálního humeru zvýšilo významně procento operovaných pacientů.

The authors analyze the results of their long-term follow-up of basic epidemiological characteristics in fractures of proximal humerus (1 464 patients), distal radius (2 514 patients), proximal femur (3 340 patients) and fracture-dislocation of the ankle (1 195 patients). In fractures of the proximal femur, the average age was 78 years; 71.6 years in men and 80.3 years in women; male-female ratio was 27:73. In fractures of the proximal humerus, the average age was 67 years; 58.8 years in men and 71.2 years in women; male-female ratio was 30:70. In fractures of the distal radius, the average age was 59 years; 45.8 years in men and 64.7 years in women; male-female ratio was 29:71. In fracture-dislocation of the ankle the average age was 49 years; 43.4 years in men and 54.7 years in women; male-female ratio was 50:50. Until 5th decade men had higher representation in all groups of fractures, starting from 6th decade the ratio changed. Introduction of new implants (locking plate, new generation of nails) for fractures of the distal radius and proximal humerus increased significantly the percentage of patients operated on.

• MeSH
• Joint Dislocations economics   epidemiology   surgery   MeSH
• Financing, Organized MeSH
• Femoral Fractures economics   epidemiology   surgery   MeSH
• Humeral Fractures economics   epidemiology   surgery   MeSH
• Radius Fractures economics   epidemiology   surgery   MeSH
• Ankle Joint surgery   MeSH
• Orthopedic Procedures statistics & numerical data   MeSH
• Age Factors MeSH

PURPOSE OF THE STUDY The presented study was construed as a retrospective multicentric clinical study focused on paediatric skeletal injuries of the proximal radius. As a general rule, the Type I displaced fractures (Judet classification) are treated conservatively, with no reduction. In the case of Type II-IV displacement, the fracture necessitates reduction or is also transfixed by a Kirschner wire (K-wire) or a Prevot nail (P-nail) where subsequent fragment instability occurs. The comparison aimed to ascertain whether there is a statistically significant difference between the two methods. No difference was expected by the authors, therefore a null hypothesis was set. MATERIAL AND METHODS The patients were treated at the Clinic of Paediatric Surgery, Orthopaedics and Traumatology (CPSOT) of the Faculty of Medicine of the Masaryk University and at the Clinic of Orthopaedics and Traumatology of the Musculoskeletal System of the University Hospital in Pilsen in the period from 2006 to 2015. Two methods of closed reduction and minimally- invasive osteosynthesis were evaluated. The first method was the elastic stable intramedullary nailing (ESIN) with a P-nail, the second method was an osteosynthesis using a K-wire. In the clinical part of the study, comparisons were made based on the monitoring of the same parameters - final restriction of movement, time to full weight bearing of the extremity and incidence of serious complications. RESULTS The final group comprised a total of 31 patients, of whom 7 boys and 24 girls aged 3-16 years with the median of 9-10 years. Some restriction of movement following the treatment occurred in a total of seven patients (44%) with the K-wire and in four patients (27%) with the P-nail. When comparing the movement at 5% level of significance using the Chi-Square tests, no significant difference was found (p = 0.446). When evaluating the serious complications at 5% level of significance using the Chi-Square tests, the difference between the two methods of treatment was again insignificant (p = 0.365). When the full weight bearing was compared (median K-wire 8 weeks, median P-nail 10 weeks), a statistically significant difference was obtained at 5% level of significance using the Fischer exact test (p = 0.003). DISCUSSION In these fractures, usually the metaphysis or the physis are involved in the injury, in which case the fractures are classified according to Salter and Harris, with the most frequent occurrence of SHII epiphyseal separation and rare SHIII and SHIV epiphyseal fractures. The radial head fractures are mostly caused by valgus force. Therefore, the individuals with a higher elbow valgosity are more prone to injuries. The girls strongly prevail (77%) also in our study. In general, our results as well as the literature have proven that as the displacement increases, the necessity of closed reduction and osteosynthesis grows. The post-treatment complications in our group were observed in 35.5% of patients, namely most often in the form of limited movement. The literature refers to complications in 26.5-53% of patients. CONCLUSIONS The clinical results clearly show that when comparing the complications after the radial head fracture in children there is no statistically significant difference between the methods of osteosynthesis. This study shall serve as a starting point for the currently ongoing prospective multicentric study evaluating the modified ESIN technique using a pre-bent Kirschner wire. Key words:children, fracture, radius, proximal, osteosynthesis.

• MeSH
• Child MeSH
• Radius Fractures * diagnosis   surgery   MeSH
• Fracture Fixation, Intramedullary * adverse effects   instrumentation   methods   MeSH
• Conservative Treatment * adverse effects   methods   MeSH
• Bone Wires MeSH
• Bone Nails * MeSH
• Humans MeSH
• Minimally Invasive Surgical Procedures methods   MeSH
• Adolescent MeSH
• Postoperative Complications * diagnosis   etiology   MeSH
• Child, Preschool MeSH
• Radius * diagnostic imaging   injuries   surgery   MeSH
• Range of Motion, Articular MeSH
• Treatment Outcome MeSH
• Check Tag
• Child MeSH
• Humans MeSH
• Adolescent MeSH
• Male MeSH
• Child, Preschool MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Clinical Trial MeSH
• Multicenter Study MeSH

CÍL: Cílem této studie bylo zhodnotit rizika spojená s léčbou nestabilních zlomenin distálního radia Mi - kronailem. Na kadaverech bylo hodnoceno riziko penetrace distálních zamykatelných šroubů do ra - diokarpálního skloubení nebo jejích umístění pro - ximálně od subchondrální kosti a riziko jejích pro - niknutí do dorzální nebo volární plochy distálního radia. MATERIÁL A METODIKA: Mikronail byl aplikován 40 kadaverózních distálních radií. Kortikální okno pro vstup Mikronailu bylo umístěno v třech různých lo - kalitách: v I. extenzorovém kompartmentu, mezi I. a II. extenzorovým kompartmentem a ve II. exten - zorovém kompartmentu. Kortikální okno bylo pro - vedeno také na třech různých vzdálenostech od hrotu processus styloideus radii (0,5, 1,0 a 1,5 cm). Šrouby byly umístěny v různých úhlech rotace Mik - ronailu. VÝSLEDKY: Optimální poloha pro kožní incizi je 0,5 cm proximálně od hrotu processus styloideus radii, na dorzální třetině výšky distálního radia, v délce 2,0 cm proximálním směrem. Kortikální okno pro vložení Mikronail ™ je 1,0 cm proximál - ně od hrotu processus styloideus radii mezi I. a II. extenzorovým kompartmentem s jeho zaváděním v 0° rotaci v transverzální rovině. V této poloze jsou rizika jeho použití nejmenší. ZÁVĚR: Léčba zlomenin distálního radia nitrodře - ňovou fixací Mikronailem je miniinvazivním chirur - gickým řešení. Použitím správné operační techniky a správný výběr pacientů vede k úspěšným výsled - kům s minimální kloubní nebo kortikální penetra - cí šroubů a s minimálním rizikem poškození či po - dráždění měkkých tkání.

OBJECTIVE: The purpose of the study was to esti - mate the range of risks related to the treatment of unstable fractures of distal radius with Micronail™. In this study were evaluated, on cadavers, the inci - dence of penetration of distal locking screws into the radiocarpal joint or their displacement proxi - mally from subchondral bone; and the incidence of their penetration into the dorsal or volar surface of radius. MATERIAL AND METHODS: The Micronail was pla - ced in 40 cadaver distal radii. Cortical window for Micronail insertion was made in different locations: in I. extensor compartment, between I. and II. exten - sor compartments and in II. extensor compartment. Cortical window was made also in three different distances from the tip of radial styloid (0.5, 1.0 and 1.5 cm). The screws were placed at different angles of rotation of Micronail. RESULTS: Optimal position for skin incision is about 0.5 cm proximal from the tip of radial styloid, on dorsal third of altitude of the distal radius, and ex - tends for 2.0 cm proximally. The cortical window for Micronail™ insertion is about 1.0 cm proximal from the tip of radial styloid between I. and II. extensor compartments in 0° tilt in transversal plane. In this position, the risks of this treatment are the least. CONCLUSION: Treatment of distal radius fracture by intramedullary fixation with Micronail™ is a miniin - vasive surgical option. Applying the correct surgi - cal technique and proper patient selection lead to successful outcomes with minimum articular or cor - tical penetration and minimum risks of soft tissue injury or irritation.

• MeSH
• Radius Fractures surgery   MeSH
• Risk Assessment statistics & numerical data   MeSH
• Fracture Fixation, Intramedullary * methods   statistics & numerical data   adverse effects   MeSH
• Bone Nails MeSH
• Humans MeSH
• Minimally Invasive Surgical Procedures methods   MeSH
• Cadaver MeSH
• Check Tag
• Humans MeSH
• Publication type
• Evaluation Study MeSH

Cíl: Práce vyhodnocuje v prospektivní studii jednoroční výsledky osteosyntéz zlomenin distální části radia pomocí nitrodřeňového hřebu Targon® DR (Aesculap, Tuttlingen, Germany). Hřeb je určen k osteosyntéze zlomenin bez nitrokloubního průběhu a jednoduchých nitrokloubních zlomenin. Materiál a metoda: V prospektivní studii sledujeme pacienty se zlomeninami distálního radia, kteří byli operováni na traumatologickém oddělení FN v Motole od května roku 2006 do ledna roku 2007. Do naší studie je zahrnuto 16 zlomenin ze skupiny A a C dle AO klasifikace. Funkční a rentgenové výsledky byly hodnoceny po 8 týdnech, 6 měsících a 1 roce od operace. Dále byly hodnoceny skóre podle Gartlanda a Werleye, Castainga a DASH. Repozice zlomeniny je prováděna pod rentgenovou kontrolou, k dočasné stabilizaci jsou používány Kirschnerovy dráty. Zavedení vlastního hřebu je retrográdní z oblasti processus styloideus radii. Šrouby proximálního i distálního jištění hřebu jsou nezamčené. Výsledky: Průměrná doba RTG hojení byla 8 týdnů. Průměrná délka radia vůči ulně v odstupu jednoho roku od operace byla + 0,5 mm, průměrný sklon kloubní plochy radia byl 1,4°dorzálně. Průměrné funkční výsledky byly následující: volární flexe 65°, dorzální flexe 63°, radiální dukce 26°, ulnární dukce 40°, pronace 88° a supinace 88°. Síla stisku ruky byla 85% ve srovnání s druhou stranou. Diskuse: Rentgenové výsledky jsou lepší než výsledky prezentované při užití transfixace Kirschnerovými dráty a srovnatelné s výsledky při užití zamykatelných dlah. Funkční výsledky v našem souboru odpovídají výsledkům publikovaným v pracích hodnotících zamykatelné dlahy. Z komplikací hodnotíme jako nejzávažnější ztrátu korekce a následný dorzální sklon kloubní plochy, k čemuž došlo dvakrát, vždy v terénu osteoporózy. Závěr: Hřeb Targon DR je vhodný zejména k ošetření zlomenin distálního radia bez nitrokloubního průběhu u pacientů mladších věkových skupin. Výhodou implantátu je miniinvazivita operace. Minimalizuje délku imobilizace a umožňuje časné zahájení rehabilitace. Problém osteosyntézy nejsložitějších nestabilních extraartikulárních i intraartikulárních zlomenin distálního radia neřeší. Naše práce však hodnotí pouze malý soubor pacientů, možnosti využití hřebu Targon DR k osteosyntézám zlomenin distálního radia budou ještě upřesňovány.

Aim: Prospective assessment of one-year results of distal radius osteosyntheses using the Targon® DR (Aesculap, Tuttlingen, Germany) intramedullary nail. The nail is designed for osteosynthesis of nonarticular fractures and of simple intraarticular fractures. Material and Methods: The prospective study includes patients with distal radius fractures, operated in the Motol Faculty Hospital Department of traumatology from May 2006 to January 2007. The study includes 16 A and C (AO classification) fractures. Functional and X-ray results were assessed at 8 weeks, 6 months and one year after the procedure. Furthermore, Gartland and Werley scores, Castaing and DASH scores were assessed. The fracure respositioning is performed under X-ray control, Kirschner wires are used for temporary stabilization. The nailing is retrograde, the nail is introduced from the processus styloideus radii region. The proximal and distal nail stabilization screws are unlocked. Results: The average period of X-ray healing was 8 weeks. The average radius/ulna length difference was +0.5 mm at one year after the procedure. The average radical tilt was 1.4°dorsally. The average functional results were the following: palmar flexion 65°, dorsal flexion 63°, radial duction 26°, ulnar duction 40°, pronation 88° a supination 88°. The handgrip strength was 85% of that on the other side. Discussion: X-ray results were superior to those when Kirshner wires transfixation was used and similar to those when locking casts were used. The study group’s functional results correspond to those presented in published studies assessing locking casts. Loss of correction and consequent dorsal radial tilt is considered the most serious complication recorded. It occurred twice, in both cases in osteoporotic conditions. Conclusion: The Targon DR nail is, in particular, suitable for the management of nonarticular distal radius fractures in younger patients. The miniinvasive character of the procedure is the implant’s advantage. It helps to minimize duration of immobilization and facilitates early introduction of rehabilitation. However, it does not solve the problem of osteosynthesis of the most complicated unstable extraarticular and intraarticular distal radius fractures. However, the study group assessed was small and the options for the Targon DR nail use in distal radius osteosynthesis will be studied further.

• MeSH
• Radius Fractures surgery   MeSH
• Fracture Fixation, Intramedullary methods   utilization   MeSH
• Bone Nails utilization   MeSH
• Humans MeSH
• Minimally Invasive Surgical Procedures methods   utilization   MeSH
• Orthopedic Procedures methods   rehabilitation   utilization   MeSH
• Prospective Studies MeSH
• Radiography methods   utilization   MeSH
• Outcome and Process Assessment, Health Care statistics & numerical data   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Tables MeSH

PURPOSE OF THE STUDY The aim of the study was to assess the functional outcomes of rehabilitation in patients with surgically treated distal radius fractures in the early postoperative period. We compared the functional outcomes of patients undergoing standard rehabilitation with the group of patients whose postoperative rehabilitation was extended with shoulder girdle exercises of the affected upper limb while the wrist was immobilized. Several indices and variables were used for the assessment of the functional therapeutic outcomes of the affected wrist. MATERIAL AND METHODS Forty patients (32 females and 8 males, the mean age 60.5 years) with distal radius fractures treated by internal fixation using volar surgical approach were involved in the study between 2013-2016. The tested subjects were randomized and split into two groups according to the selected method of rehabilitation. The tested subjects with standard rehabilitation extended with shoulder girdle muscles activation were labelled as group I. It included patients (n = 20) of the mean age 59.8 (age range 42-73 years) with immobilized wrist (i.e. for 3-4 weeks) performing shoulder girdle muscles exercises at the same time. Furthermore, standard kinesiotherapy continued after their fixation was removed. The other tested group, labelled as group II (n = 20), the mean age 61.3 (variation 40-74 years of age) involved patients with distal radius fractures. Only standard rehabilitation was performed in this group as late as their forearm fixation was removed. The following indices and parameters were assessed in the early postoperative period (i.e. by 8 weeks after the fixation removal): wrist and fingers range of motion (ROM), hand grip strength (dynamometry), local swelling, pain, scores of a nine hole peg test (NHPT), and a DASH score. RESULTS After the fixation had been removed, the group I reported statistically significantly higher values of movement compared to the values of the contralateral limb in the following directions: dorsal flexion, palmar flexion, MP joints flexion, flexion of PIP joints (proximal interphalangeal), and flexion of DIP joints (distal interphalangeal). After eight weeks, the group I manifested significantly higher values in dorsal flexion, palmar flexion and ulnar deviation in the wrist. There were no significant differences in other movement directions. The hand grip strength mean value examined with a dynamometer was significantly higher in the group I in the sixth and eighth week of testing (group I - 58.9% strength of a healthy limb after six weeks, or 66.5% after eight weeks). The results in the group II were 49.9% strength of a healthy limb after six weeks, or 56.6% after eight weeks. The group I showed statistically significantly lower values of wrist swelling and higher finger dexterity in the NHPT in all measured weeks. Lower pain intensity in the group I during the measurements was observed. At the same time, this group showed significantly better results in the DASH score. DISCUSSION The results of this study are useful for clinical practice. They confirm a functional relation between the activity of hand muscles and the shoulder muscle activity. The differences in the functional ability of the hand and the functional state of the injured wrist were detected as early as in the early postoperative period. It could be stated that the tested subjects in the group I showed a greater and faster improvement in the physical function of the injured hand. This was also accompanied by a positive psychological effect. We had not found a study of a similar type in the available literature that we could have compared our submitted results to. CONCLUSIONS Shoulder girdle muscles exercises after a distal radius fracture, while wrist is immobilized, can evidently enhance functional capability and accelerate the hand-function restitution. Early functional outcomes of the injured wrist after the rehabilitation with shoulder girdle muscles exercises support the efficiency of this broadened rehabilitation protocol. Key words: distal radius frac,ture, hand, shoulder, functional treatment, rehabilitation.

• MeSH
• Adult MeSH
• Radius Fractures rehabilitation   surgery   MeSH
• Immobilization adverse effects   methods   MeSH
• Muscle, Skeletal * physiopathology   MeSH
• Middle Aged MeSH
• Humans MeSH
• Shoulder * physiopathology   MeSH
• Range of Motion, Articular MeSH
• Aged MeSH
• Hand Strength MeSH
• Exercise Therapy methods   MeSH
• Fracture Fixation, Internal adverse effects   methods   rehabilitation   MeSH
• Treatment Outcome MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Randomized Controlled Trial MeSH

CONTEXT: The low bone mineral density (BMD) and alterations in bone geometry observed in patients with Turner syndrome (TS) are likely caused by hypergonadotropic hypogonadism and/or by haploinsufficiency of the SHOX gene. OBJECTIVE: Our objective was to compare BMD, bone geometry, and strength at the radius between prepubertal girls with TS and children with isolated SHOX deficiency (SHOX-D) to test the hypothesis that the TS radial bone phenotype may be caused by SHOX-D. DESIGN AND SETTING: This comparative cross-sectional study was performed between March 2008 and May 2011 in 5 large centers for pediatric endocrinology. PATIENTS: Twenty-two girls with TS (mean age 10.3 years) and 10 children with SHOX-D (mean age 10.3 years) were assessed using peripheral quantitative computed tomography of the forearm. MAIN OUTCOMES: BMD, bone geometry, and strength at 4% and 65% sites of the radius were evaluated. RESULTS: Trabecular BMD was normal in TS (mean Z-score = -0.2 ± 1.1, P = .5) as well as SHOX-D patients (mean Z-score = 0.5 ± 1.5, P = .3). At the proximal radius, we observed increased total bone area (Z-scores = 0.9 ± 1.5, P = .013, and 1.5 ± 1.4, P = .001, for TS and SHOX-D patients, respectively) and thin cortex (Z-scores = -0.7 ± 1.2, P = 0.013, and -2.0 ± 1.2, P < .001, respectively) in both groups. Bone strength index was normal in TS as well as SHOX-D patients (Z-scores = 0.3 ± 1.0, P = .2, and 0.1 ± 1.3, P = .8, respectively). CONCLUSIONS: The similar bone geometry changes of the radius in TS and SHOX-D patients support the hypothesis that loss of 1 copy of SHOX is responsible for the radial bone phenotype associated with TS.

• MeSH
• Sex Chromosome Aberrations MeSH
• Child MeSH
• Genetic Association Studies MeSH
• Genetic Diseases, Inborn genetics   metabolism   pathology   physiopathology   MeSH
• Haploinsufficiency * MeSH
• Homeodomain Proteins genetics   metabolism   MeSH
• Bone and Bones chemistry   pathology   MeSH
• Bone Density MeSH
• Humans MeSH
• Mechanical Phenomena MeSH
• Adolescent MeSH
• Mutation MeSH
• Growth Disorders etiology   MeSH
• Cross-Sectional Studies MeSH
• Radius MeSH
• Turner Syndrome genetics   metabolism   pathology   physiopathology   MeSH
• Child Development MeSH
• Bone Development * MeSH
• Bone Diseases, Developmental etiology   MeSH
• Check Tag
• Child MeSH
• Humans MeSH
• Adolescent MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Multicenter Study MeSH
• Research Support, Non-U.S. Gov't MeSH
• Comparative Study MeSH
• Geographicals
• Czech Republic MeSH