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Carpal tunnel syndrome, Colles' fracture, and osteoarthritis of the basilar joint of the thumb are only three of the many upper extremity conditions that preferentially affect women. With more and more women entering the workplace, these conditions become more disruptive of patients' lifestyles and even may be increasing in incidence. Orthopaedic surgeons traditionally have focused on the surgical treatment of patients with these conditions, but it is becoming increasingly clear that surgeons also must focus on delineating pathophysiology to better identify those individuals at risk and help prevent these potentially disabling disorders.

Displaced fractures of the distal radius are difficult to treat successfully by traditional nonoperative methods. The goal in the management of these fractures is to achieve extraarticular alignment and an articular step off of less than 2 mm. Cast immobilization has been supplemented with pins and plaster technique and external fixators. Percutaneous are limited open reduction techniques, combined with wrist arthroscopy, have been shown to be useful in the management of intraarticular distal radius fractures. Despite these advances, there are still a significant number of fractures in which the articular surface cannot be reconstructed without open reduction and internal fixation. The main objective is to restore articular integrity as perfectly as possible. Attention to meticulous surgical technique will facilitate good results. When articular restoration cannot be accomplished, early arthrodesis or arthroplasty should be indicated. In the absence of osteoarthritis, intraarticular osteotomy can be used for intraarticular malunions with a step off greater than 2 mm. Radius malalignment usually requires a dorsal opening wedge osteotomy, insertion of a corticocancellous graft, and a dorsal buttress plate. Early recognition and treatment of distal radioulnar joint injuries associated with fractures of the distal radius are paramount to reduce the incidence of painful sequelae and functional deficits.

A low intensity ultrasound device was investigated as an accelerator of cortical and cancellous bone fracture healing in smokers and nonsmokers. Statistically significant reductions in healing time for smokers and nonsmokers were observed for tibial and distal radius fractures treated with an active ultrasound device compared with a placebo control device. The healing time for a tibial fracture was reduced 41% in smokers and 26% in nonsmokers with the active ultrasound device. Similarly, distal radius fracture healing time was reduced by 51% in smokers and 34% in nonsmokers with the active device. Treatment with the active ultrasound device also substantially reduced the incidence of tibial delayed unions in smokers and nonsmokers. The use of the active ultrasound device accelerates cortical and cancellous bone fracture healing, substantially mitigates the delayed healing effects of smoking, speeds the return to normal activity, and reduces the long-term complication of delayed union.

The most common cause of residual wrist disability after fractures of the distal radius is the distal radioulnar joint. The 3 basic conditions that produce radioulnar pain and limitation of forearm rotation are instability, joint incongruency, and ulnocarpal abutment. The last 2 entities initiate irreversible cartilage damage that eventually leads to degenerative joint disease. Early recognition and management in the acute stage aim at the anatomic reconstruction of the distal radioulnar joint including bone, joint surfaces, and ligaments in an effort to reduce the incidence of painful sequelae and functional deficit. This article provides a description and the treatment options of the distal radioulnar joint lesions that occur in association with fractures of the distal radius, and the results obtained with open and arthroscopic techniques. Both acute and chronic disorders are analyzed, and a prognostic and treatment oriented classification is presented Furthermore, the pathoanatomy and management of chronic distal radioulnar joint derangement after fracture of the distal radius are reviewed briefly.

In a prospective investigation in 1984 and 1985, all Colles' fractures (not comminuted or intraarticular) that redisplaced after two closed reductions were allocated at random to one of two groups: Group I (n = 23), in which the dorsal bone deficiency was filled with bone cement (methylmethacrylate), and Group II (n = 25), in which the fracture was treated with external fixation. All were followed for one year and examined with respect to anatomy of the fracture, wrist movement, strength, appearance, pain, function, and complications. Roentgenograms, 12 months after treatment, showed that all fractures had healed and that the cement was enveloped in cortical bone. The final results were equal in the two groups, but Group I improved earlier and had no complications.

In a prospective study, 156 Colles' fractures were treated with a functional Orthoplast brace. Approximately one-half were braced in pronation and one-half in supination. One hundred and four were available for follow-up. Results were analyzed by type of fracture and position of immobilization (pronation versus supination). In evaluating the results, we found that: (1) displaced Colles' fractures without articular involvement (Type II) braced in supination yielded superior anatomic results when compared with those treated in pronation; (2) Type IV (displaced intra-articular) fractures braced in supination obtained a significantly higher percentage of excellent functional and anatomic results than those braced in pronation. In general, treatment with functional bracing yielded 90% excellent or good functional results.

One question which often confronts the clinician is whether or not a Colles' fracture, shown to be redisplaced, should be subjected to renewed reduction. Earlier reports have shown a rather good correlation between the accuracy of reduction and the functional and cosmetic end result. Roentgenograms of 40 rereduced Colles' fractures are reviewed in order to answer the following questions. What are the chances of a lasting improvement resulting from a renewed reduction of a redislocated Colles' fracture? What is the most suitable time for renewed reduction? Permanent improvement was found in about 1/3 of all the case. To establish the most suitable time for rereduction the material was divided into early rereduced (1-6 days after primary reduction) and late rereduced (7-15 days) fractures. It was found that early rereduction led to lasting improvement of the fractures position in only 2 of the 15 cases. Late rereduction led to permanent improvement in 15 of 30 cases with respect to dorsal angulation and in 9 cases to radial compression. If a rereduction is to be performed, it should be done during the second week after primary reduction.

This study compares 75 consecutive patients with Frykman Type VIII fractures of the distal forearm treated by primary external fixation with 32 patients who sustained similar injuries and were treated by closed reduction and cast immobilization. The latter group of patients served as an historical control. The two groups were similar with respect to injury and demographic characteristics. All fractures treated with external fixation remained well reduced and aligned, whereas 88% of those treated with casts had unsatisfactory alignment despite the fact that 30% had a second reduction. The external fixator group also had superior results with respect to functional outcome, range of motion, and grip strength.

Since 1969, seven orthopedic dissertations on the following subjects were submitted from the author's hospital. Postoperative use of special elastic bandages and oxyphenbutazone significantly decreased the frequency of thrombosis. Use of a randomized single-blind technique significantly improved chronic cases of lumbago by a new traction treatment called auto-traction. Two control groups were treated by bed rest and analgesics or routine physiotherapy measures. With a new mechanical device for tibial osteotomy, the precision of the angular change was significantly increased. In intracapsular hip fractures treated by Deyerle's technique, only 18% had necrosis of the femoral head after two years. By use of a new radiologic method for determining the stability of tibial fractures it was possible to determine a stability quotient; the quotient established the point at which the fracture could be mobilized without risk of delayed union or pseudarthrosis. In shoulder joint dislocations, three to four weeks of immobilization resulted in a recurrence rate equal to that of ordinary treatment in a sling. In a randomly selected group of people in Sweden, the incidence of shoulder dislocations was 2%. Forty percent of these patients had never seen a doctor. In Colles' fracture, the uptake of radioactive Tc-MDP was significantly increased by treating the fracture with electromagnetic fields. Arthroscopic percutaneous meniscectomies reduced the operation time normally required for an arthrotomy by an average of 30 minutes.

The long-term results of the conservative treatment of wrist fractures were observed in a follow-up study of 297 cases over a period of one and one-half years to six years. The evaluation of the results was based on clinical parameters, both subjective and objective, as well as radiological features. The results were: excellent in 38% of cases, good in 49%, fair in 11.5%, and poor in 1.5%; considerably worse were the subjective results (20% fair to poor). No statistically significant relation could be found between results and type of fracture. Clinical deformities and pain in the area of the distal radioulnar joint were frequent. Decrease in grip strength was observed in 17.8% of cases. A limitation of wrist movement was not frequent. Numerous compressive neuropathies were found (41 in 35 patients), especially of the median nerve. The values relative to the three radiographic parameters under investigation (that is, radial deviation, volar tilt, and radioulnar index) were often found to be out of the normal range. The comparative study of postreduction and follow-up radiograms show the loss of reduction to be frequent, especially as far as the volar tilt is concerned. The frequent radiologic deformities are associated with significantly bad results only in cases of extremely abnormal values. However, fractures of the distal radius are not to be underestimated. Long-term results following conservative treatment may not be as acceptable as is generally assumed.

This randomized, controlled study was performed to evaluate how electromagnetic fields affect the accumulation of 99mTechnetium - methylendiphosphonate (Tc-MDP) in fresh fractures. Thirty women with Colles' fractures, aged 50-70 years, participated in this study--some in a control group and some in a treated group. After reduction, all patients were immobilized for four weeks. After randomization, 15 patients were treated by electromagnetic fields of extremely low frequency (EMF of ELF ), which were generated by a coil and a battery-powered portable current generator during the time of immobilization. The frequency of the alternating magnetic field was 1-1000 Hz; the magnitude was 4 gauss [RMS (root-mean-square) value]. The scintigrams were performed one, two, four, and eight weeks after the injury. The activity ratio in the fracture area was significantly higher at the examination of one and two weeks (p less than 0.05, p less than 0.01) in the treated group than it was in the control group. The clinical relevance of the results is not known, but one interpretation of the data is that the stimulation with EMF of ELF improves (accelerates) the early phase of fracture healing. The data warrant further investigation of fresh fracture treatment with this method.