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Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVII | Pages 362 - 362
1 Sep 2012
Aparicio GarcĂ­a P Izquierdo Corres O Casellas Garcia G Castro Ruiz R Cavanilles Walker JM Costa Tutusaus L Castellanos J Yunta A
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Introduction

Distal radius fractures (DRF) are a common injury in the A&E departments, being a major cause of disability of the upper extremity. The aim of this prospective study is to assess the possible association between objective physical variables such as wrist range of movement (ROM), radiological parameters, and upper extremity disability (measured by the DASH questionnaire), after conservative treatment of DRF.

Patients and methods

44 patients with non-operatively managed DRF were enrolled in a prospective cohort study from July 2007 till September 2009.

Inclusion criteria: unilateral DRF in skeletally mature patients, treated non-operatively with closed reduction and cast. Patients who sustained a previous fracture of the wrist, or bilateral wrist fracture, or with dementia, were excluded.

After the closed reduction and inmovilization of the fracture in the A&E department we asked the patients to complete the DASH questionnaire, referring to their baseline pre-fracture state.

All fractures were classified according to the AO classification.

After one year, 36 patients were still available for follow-up purposes. We assesed the following objective physical variables: ROM of both wrists: flexion/extension arc and pronation/supination arch. We recorded the following radiologic parameters: radial angulation, volar angulation and radial shortening. The patient-perceived results were measured by the DASH questionnaire, while pain was measured using the VAS scale.

Statistical analysis was performed using the SPSS 15.0.


Orthopaedic Proceedings
Vol. 91-B, Issue SUPP_II | Pages 319 - 319
1 May 2009
Izquierdo O Riera J Cavanilles JM Roca J
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Introduction and purpose: Neuropathy associated with syringomyelia is a relatively rare entity that predominantly affects the glenohumeral joint. It is characterized by joint destruction, which is in many cases severe and which requires a differential diagnosis from other severe conditions. The therapeutic options are based on maintaining function rather than on immobilization. We present our experience of treating this condition in 4 cases.

Materials and methods: The cases were 4 females with a mean age of 53.25 years. One of the cases had both the glenohumeral and carpal joints affected. Only in one case was there a known history of syrinogomyelia associated with Arnold Chari disease, whereas in the other 3 the diagnosis of syringomyelia was established by studying the neuroarthropathy.

Results: Two of the patients were treated by means of joint replacement (one total and the other partial) with a favorable postoperative evolution in the medium term. Acceptable pain control and joint balance were achieved. At the end of 5 and 2 years respectively, the total and partial prosthesis had to be revised due to aseptic loosening of the components and joint instability, respectively. The conservative treatment applied to the two remaining cases achieved a functional range of movement for activities of daily living and one of the cases was able to continue with their usual work activities.

Conclusions: In spite of numerous sources in the literature that advise against joint replacement, there are very few documented cases and series that substantiate that recommendation. In the long run, in our experience joint replacement is not a satisfactory treatment for glenohumeral neuroarthropathy.