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We describe the epidemiology of all distal radial fractures in young adults (men 20-59 years, women 20-49 years) in Lund (1992-95) and Malmö (1994-95), Sweden. During the study period, there were 341 patients with 346 fractures in the two cities, found through the Hospital Register of Diagnoses in Lund and the register of the Radiology Department in Malmö. More than half of the fractures were dislocated and 2/3 of the cases involved the radiocarpal or radioulnar joints, in contrast to the predominantly extra-articular fractures in the elderly. There was an even distribution between sexes and the fractures were mainly caused by a severe trauma, i.e., more than a simple fall, most often sports injuries in January, February and May. Our findings suggest that distal radial fractures in nonosteoporotic young adults should be regarded as a special entity, at least in epidemiological studies. Possibly they also require treatment differing from that for osteoporotic fractures.

We compared Norian SRS, an injectable calcium phosphate bone cement, with external fixation in the treatment of redisplaced distal radial fractures by a prospective randomized study in 40 patients (women 50-80 years or men 60-80 years). After rereduction, the fracture was either stabilized by injection of SRS and immobilized with a cast for 2 weeks, or externally fixed with Hoffman's bar for 5 weeks. Each patient was evaluated at 2, 5, 7 weeks and at 3, 6 and 12 months. Functional parameters were grip strength, range of motion and pain. Radiographic parameters were radial angle, ulnar variance and dorsal tilt. The chosen primary effect variable was grip strength at 7 weeks. Patients treated by injection of SRS apatite had better grip strength, wrist extension and forearm supination at 7 weeks. There was no difference in functional parameters at 3 months or later. None of the methods could fully stabilize the fracture: radiographs showed a progressive redislocation over time. The results indicate that SRS can be used in the treatment of unstable distal radial fractures. The more rapid recovery of grip strength and wrist mobility in the SRS group appears to be due to the shorter immobilization time.

109 patients with unilateral Colles' fracture, treated with closed reduction and cast immobilization, were re-examined after 4 (1-9) years. At follow-up, 40 patients had persistent ulnar wrist pain. The most important factor for predicting ulnar pain was final dorsal angulation of the radius. Initial and final radial shortening, fracture of the distal radioulnar joint, ulnar styloid fracture, or instability of the distal ulna were not correlated to ulnar wrist pain. We suggest that ulnar wrist pain following Colles' fracture is caused by incongruity of the distal radioulnar joint.

A series of 56 consecutive patients with 59 fractures of the distal end of the radius, treated with an unilateral external fixator of Hoffmann between 1980 and 1988, is presented, 47 of these patients were examined clinically at home in the last months of 1989. We can distinguish two different groups of patients: the older females with an average of 59.2 years and the younger males with an average of 40.1 years. The fractures of the females were caused by a lower energy trauma than those of the males (p less than 0.05). The males had significantly more complex fractures (Frykman type VII or VIII) than the females (p less than 0.05). The indication for an external fixation was significantly different for males and females (p less than 0.01). The external fixator remained attached for an average time of 5.7 weeks. The traumatized wrist had an average power of 71% of the heterolateral side. 87% of the patients had no complaints in performing their daily activities. In 70% there was an anatomical reduction on the X-ray, in 64% an excellent cosmetic result and in 68% the functional end results were excellent or good. Functional end results can be ameliorated by paying more attention to the anatomical reconstruction of the wrist joint. Therefore, it can be necessary to complete the external fixation with an open reconstruction of the wrist joint and/or with a transplantation of cancellous bone. In some cases, a changing of procedure to a plate osteosynthesis could be the treatment of choice.

The bone mineral content of the radius and ulna was analyzed in 31 postmenopausal women with displaced Colles' fractures. Sixteen fractures were treated with a below-the-elbow plaster case and 15 with primary external fixation. The bone mineral content of the forearm bones was measured with a photon absorptiometer 9 (6-24) months later. There was a mean 15 percent mineral decrease in the radius, but no difference between the two treatment groups. The decrease did not correlate with the age of the patient, nor was there any correlation with grip strength or range of wrist motion. The more severe fractures, according to the Frykman classification, had a more pronounced mineral loss than the simpler fractures.

In a prospective randomized study of 47 severely displaced Colles' fractures, 23 had external fixation and 24 had a dorsal plaster cast. Five fractures in the plaster-cast group redislocated and were externally fixed at rereduction after the 11-day follow-up. Three patients in the external-fixation group had a noncomplicated pin-tract infection, and 1 patient had a transient sensory disturbance arising from the cutaneous branch of the superficial radial nerve. After 1 year, the patients allocated to primary external fixation had a better radiographic and functional end result; according to Lidström's grading, 19/22 were excellent or good after external fixation as compared with 12/19 after plaster-cast treatment.

In a prospective randomized study of 99 displaced Colles' fractures, regional intravenous block was compared with local anesthesia in the fracture hematoma. Patients treated with regional intravenous block had less pain during the manipulation of the fracture and better grip strength at the 6-month follow-up. The anatomic end result (dorsal angulation) was better after regional anesthesia.

Totally, 146 Colles' fractures that were displaced after the primary reduction were treated by closed rereduction and plaster immobilization. A permanently acceptable position was achieved in 11 of 27 cases, where dorsal angulation was the only malalignment. In fractures with both axial compression and dorsal angulation, both displacements improved to a permanently acceptable position in only 7 of 105 cases, and only the dorsal angle improved to an acceptable position in 26 cases. The axial compression was most difficult to correct. The chances of achieving a permanently acceptable position by rereduction are rather small in Colles' fracture with axial compression alone or combined with deviation of the dorsal angle. High age and the presence of dorsal comminution are further factors likely to worsen the prognosis.

We present a prospective and randomized study of two different treatments of extraarticular Colles' fracture with a fractured ulnar styloid. The study comprised 41 patients with 2 years' follow-up; 22 patients were treated with closed manipulation and an above-the-elbow plaster cast, whereas in 19 patients the avulsed ulnar styloid was transfixed and/or the triangular ligament was repaired after closed reduction of the fractured radius. In all the operated on patients, a complete rupture of the triangular ligament was found. Good reduction of all the fractures was achieved primarily according to the radiographic examination. At follow-up the alignment had deteriorated, with no difference between the two treatment groups. Neither did the findings in the wrist arthrograms differ between the two groups nor did the subjective complaints of the patients. We conclude that repair of the ruptured triangular ligament in extraarticular fractures of the distal radius is not better than conventional treatment.

A series of 68 undisplaced or minimally displaced Colles' fractures was randomized into two groups undergoing treatment with either a plaster cast or an elastic bandage. Pain, function, grip strength, and range of motion were evaluated 1 year later. There was a difference in the functional outcome in favor of the patients treated with an elastic bandage, who did not have more fracture redislocations than those treated with a plaster cast.

Twenty patients with Colles' fractures were treated with a functional brace that allows wrist motion. The result was compared with a similar group of patients treated with a plaster cast. Dorsal displacement of the fracture was less and wrist function was better in the brace group. Swelling of the hand during the early stages was observed in the brace group; and because this may necessitate brace adjustment, increased medical supervision is necessary for this period.

The tendency of 267 consecutive Colles' fractures to dislocate during plaster-cast treatment was correlated with several parameters measured from the initial radiographs. Stepwise logistic regression analysis showed that radial axial shortening had the greatest prognostic power. The age of the patient and Lidström's class provided additional prognostic information. Initial radial axial shortening of 5 mm or more generally indicated an unfavorable anatomic end result.

Colles' fractures (not comminuted or intraarticular) that redislocated after two closed reductions were randomized into two groups. In one group the dorsal bone deficiency was filled with bone cement (methylmethacrylate) at operation; in the other, the fractures were rereduced and immobilized in a plaster cast. All the patients were followed for 2 years and examined with respect to anatomy of the fracture, wrist movement, strength, appearance, pain, and function. The operated on group were better with regard to all objectively measurable characteristics; all operated on fractures had healed radiographically, and the cement was surrounded by cortical bone.