The effect on supination-pronation of angular malalignment of fractures of both bones of the forearm.

Matthews, Lena; Kaufer, Herbert; Garver, D F; Sonstegard, David A.

doi:10.2106/00004623-198264010-00003

Cited by 244 publications

(133 citation statements)

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“…For these reasons, the complexity of the osteotomies differed widely among patients, the most complex correction having been done in Group 1 and the least in Group 3. We observed the major deficit in pronation or supination in some patients in Groups 1 and 2 outweighed the deficit corresponding to the observed bone deformities as documented in experimental studies [12,24,37]. We postulated that posttraumatic contracture of the interosseous membrane contributed to increase the deficit in ROM.…”

Section: Discussionsupporting

confidence: 53%

“…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: Discussionsupporting

confidence: 49%

“…Angulation of 10°of one forearm bone has little impact on motion, but combined deformities of 10°of the radius and ulna toward the interosseous membrane considerably decreases supination but not pronation [24]. Conversely, isolated 20°angulation of the radius reduces pronation in dorsal angulation and supination in volar angulation, and the same angulation toward the interosseous membrane decreases supination and pronation.…”

Section: Discussionmentioning

confidence: 96%

“…Numerous biomechanical studies have investigated the effects of angular and axial malunions of the forearm bones on limitation of ROM and DRUJ instability [3,4,6,8,12,19,20,24,25,31,33,37]. Different isolated or combined axial malunions of the radius and ulna may result in comparable forearm stiffness [12].…”

Section: Introductionmentioning

confidence: 99%

“…Derotation osteotomy of one forearm bone improves motion in the direction of the osteotomy at the expense of motion in the other direction resulting in no change in overall ROM [12,23]. Conversely, overall ROM is improved by correcting an angular deformity of the radius greater than 15°toward the interosseous membrane because this deformity alone impairs pronation and supination [24,38]. Therefore, ability to improve overall ROM through forearm osteotomies is related to the type of osteotomy that is performed, which in turn depends on the characteristics of the malunion.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Correction of Forearm Malunion Guided by the Preoperative Complaint

Nagy

Jankauskas

Dumont

2008

Clinical Orthopaedics &Amp; Related Research

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Section: Discussionsupporting

confidence: 53%

Section: Discussionsupporting

confidence: 49%

Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Correction of Forearm Malunion Guided by the Preoperative Complaint

Nagy

Jankauskas

Dumont

2008

Clinical Orthopaedics &Amp; Related Research

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Resource Utilization for Patients With Distal Radius Fractures in a Pediatric Emergency Department

et al. 2020

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IMPORTANCE Improvement of clinician understanding of acceptable deformity in pediatric distal radius fractures is needed. OBJECTIVE To assess how often children younger than 10 years undergo a potentially unnecessary closed reduction using procedural sedation in the emergency department for distal radial metaphyseal fracture and the associated cost implications for these reduction procedures. DESIGN, SETTING, AND PARTICIPANTS This retrospective cross-sectional study included 258 consecutive children younger than 10 years who presented to a single, level I, pediatric emergency department and who had a distal radius fracture with or without ulna involvement between January 1, 2016, and December 31, 2017. Reductions were deemed to be potentially unnecessary if the coronal and sagittal plane angulation of the radius bone measured less than 20°and shortening measured less than 1 cm on initial injury radiographs. Use of procedural sedation or transfer status to another facility was noted if present. Statistical analysis was performed from April 2019 to June 2019. MAIN OUTCOMES AND MEASURES Potentially unnecessary reduction was the primary outcome. Radiographic findings were measured to determine reduction necessity. Additional variables measured were age, sex, time in the emergency department, transfer status, required reduction procedure, use of sedation, and cost associated with care. RESULTS Of the 258 participants studied, 156 (60%) were male, with a mean (SD) age of 6.7 (2.3) years. Among 142 patients (55%) who underwent closed reduction with procedural sedation in the emergency department, 38 (27%) procedures were determined to be potentially unnecessary. Review of Common Procedural Terminology charges revealed an approximately $7000 difference between the stated cost of a reduction procedure in the emergency department vs a cast application in an outpatient orthopedic clinic for distal radial metaphyseal fractures. The mean (SD) maximal angulation in either plane for fractures that underwent appropriate reduction was 30.6°(10.3°) compared with 13.9°(4.5°) for those unnecessarily reduced (P < .001). Patients who were transfers from other facilities were more than twice as likely to undergo a potentially unnecessary reduction (odds ratio, 2.3; 95% CI, 1.1-5.0; P = .03). CONCLUSIONS AND RELEVANCE The findings suggest that improved awareness of these acceptable deformities in young children may be associated with limiting the number of children requiring reduction with sedation, improving emergency department efficiency, and substantially reducing health care costs.

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Angular deformities and forearm function

Sarmiento

Ebramzadeh

Brys

et al. 1992

Journal Orthopaedic Research

106

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Angular deformities were created in cadaver forearms at proximal, middle, and distal third levels of the radius and ulna separately, and at middle and distal third levels of both bones, to determine the corresponding limitations of pronation and supination. The ranges of pronation and supination were recorded using a rotational motion measurement apparatus instrumented with a 360 degrees goniometer. These experimental results were compared to data obtained from clinical and radiographic examination of 105 patients with similar residual deformities following treatment of fractures by nonsurgical means, to evaluate the accuracy of the experimental model and to determine if loss of rotational motion could be predicted based on radiographic findings. With cadaver forearms, on the average, angulation of 10 degrees of the radius or ulna in coronal or sagittal planes limited pronation and supination by less than 24 degrees, whereas angulation of 10 degrees of both the radius and the ulna limited pronation and supination by less than 18%. Comparison of experimental results with clinical findings showed that, despite the errors involved in measuring forearm deformities in patients using biplanar radiographs, the experimental results predicted the clinical loss of pronation and supination to within 17% for the fractures of the radius, and within 8% accuracy for the fractures of the ulna.

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The effect on supination-pronation of angular malalignment of fractures of both bones of the forearm.

Cited by 244 publications

References 0 publications

Correction of Forearm Malunion Guided by the Preoperative Complaint

Correction of Forearm Malunion Guided by the Preoperative Complaint

Resource Utilization for Patients With Distal Radius Fractures in a Pediatric Emergency Department

Angular deformities and forearm function

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