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BACKGROUND: To break or not to break-That is the question that has been asked in pediatric traumatology for many years regarding the treatment of greenstick fractures of the diaphyseal forearm shaft. OBJECTIVE: The frequency of greenstick fractures of the forearm shaft in children and adolescents; the influence of breaking the fracture on the refracture rate. METHODS: Analysis and discussion of relevant articles, analysis of the refracture rate of pediatric greenstick fractures of the forearm shaft in our own patient population. RESULTS: Greenstick fractures frequently occur in the area of the forearm shaft and incomplete consolidation leads to an increased refracture rate. In the patient collective of the authors of 420 children with greenstick fractures of the diaphyseal forearm, there was a refracture rate of 9.5%; however, the rate for non-completed fractures was significantly higher compared to the group with completed fractures (15.2% vs. 3%). While in the subgroup of conservatively treated fractures (n = 234), breaking the intact cortex significantly reduced the refracture rate, breaking the intact cortical bone during surgical treatment with elastic stable intramedullary nailing (ESIN) did not change the refracture rate. CONCLUSION: As part of the conservative treatment of greenstick fractures of the diaphyseal forearm, completing the fracture can be recommended in order to lower the refracture rate. Completing the fracture does not appear to be necessary during surgical treatment using ESIN.

UNLABELLED: Long-term physical functioning trajectories following distal forearm fracture are unknown. We found that women with versus those without distal forearm fracture were more likely to experience a 5-year decline in physical functioning, independent of initial physical functioning level. This association was most evident among women 80 years and older. INTRODUCTION: Physical functioning trajectory following lower arm or wrist fracture is not well understood. PURPOSE: This study is to evaluate physical functioning trajectory before vs. after lower arm or wrist fracture, stratified by age. METHODS: We performed a nested case-control study of prospective data from the Womens Health Initiative Study (n = 2097 cases with lower arm or wrist fracture, 20,970 controls). Self-reported fractures and the physical functioning subscale of the RAND 36-item Short-Form Health Survey were assessed annually. We examined three physical functioning trajectory groups: stable, improving, and declining. RESULTS: Mean (SD) number of physical functioning measurements was 5.2 (1.5) for cases and 5.0 (1.4) for controls. Declining physical functioning was observed among 20.4% of cases and 16.0% of controls. Compared to women without lower arm or wrist fracture, women with lower arm or wrist fracture were 33% more likely to experience declining physical functioning (adjusted odds ratio [aOR] 1.33 95% confidence interval [CI] 1.19-1.49, reference group stable or improving physical functioning trajectory). Associations varied by age: age ≥ 80 years aOR 1.56 (95% CI 1.29-1.88); age 70-79 years aOR 1.29 (95% CI 1.09-1.52); age

Context It is unknown if isolated low bone mineral density (BMD) "osteoporosis" at the radius is associated with increased fracture risk, not only at the wrist but elsewhere, and whether it reflects more generalized skeletal fragility. Objective This work aimed to review the association of radius BMD and fracture risk, the epidemiology of wrist fractures, isolated osteoporosis at the radius, and the concordance between radial BMD and femoral neck BMD. Methods We completed a narrative literature review on radius BMD and fracture risk and current recommendations for measurement of radial BMD. We updated results of radial BMD and fracture results from the Study of Osteoporotic Fractures over 20 years and examined the concordance of BMD at the distal and proximal radius with femoral neck BMD T scores. Results Radius BMD is a robust predictor of all types of fractures including hip and wrist but there is insufficient evidence to suggest that radius BMD predicts wrist fractures better than fractures at other sites. Fractures of the wrist tend to occur in younger, healthier women compared with hip and spine fractures. Nevertheless, wrist fractures are associated with an increased risk of future fractures and represent a missed opportunity for intervention. On a population level, the discordance between radius BMD and femoral neck BMD is small. But women with isolated osteoporosis at the radius had biochemical and microarchitecture deterioration that were similar to women with hip osteoporosis. Conclusion Future research should address the clinical implications of isolated osteoporosis at the radius and whether treatment is warranted. [ABSTRACT FROM AUTHOR]

Purpose: Sclerotic lines have been detected at specific locations on the forearm and metaphysis of the lower extremities (femur and tibia) in some patients with atypical femoral fractures (AFFs) associated with long-term bisphosphonate (BP) use. Herein, we present our preliminary data relating to the factors associated with the occurrence of sclerotic lines in patients diagnosed with AFFs. Methods: We inspected the clinical charts of patients who were prescribed BPs at our institution between 2010 and 2020. Fifty-six patients were finally investigated, including patients with sclerotic line lesions at the radial tuberosity (21 patients), and those without any pathognomonic lesions on either radius on a simple radiograph (35 patients). Results: No significant between-group differences in basic demographic characteristics, bone mineral density, or the total period of BP administration were observed (p>0.05). Multivariate analyses of the variables that exhibited significant between-group differences in the univariate analyses demonstrated that the time since the last BP administration at the time of AFF diagnosis (odds ratio [OR], 0.441) and the concurrent presence of similar lines on the femur (OR, 36.00) were significantly associated with the presence of sclerotic lines on the proximal radius. The cutoff time after the last BP administration at the time of AFF diagnosis was 16.5 months, which may serve as a predictor for the development of a sclerotic line around the radial tuberosity. Conclusion: Sclerotic lines on the proximal radius were detected more frequently in patients who had been recently treated with a BP or had similar lines on the lower extremities. [ABSTRACT FROM AUTHOR]

Simple Summary: This case report follows the recovery of a seven-month-old Pomeranian who had a serious fracture in its forelimb. The patient needed two surgeries to fix the fracture and help the bone heal using advanced methods. First, an external frame was used to keep the bone in place, along with a special material to help the bone grow. Although the bone initially healed well, problems with the frame caused the need for a second surgery. In the second surgery, a plate was added to support the bone, and a new healing material was used. After almost five years, the patient had less movement in the injured leg but did not seem to be in pain. X-rays showed only small changes in the joints, and although CT scans showed differences in leg length and bone density, the patient's ability to bear weight on the treated leg improved significantly. This case shows that combining these advanced techniques can be a good approach for treating complex fractures in veterinary practice. A seven-month-old male Pomeranian presented with left forelimb lameness after a fall. Radiographic assessment confirmed proximal radial head and ulnar comminuted fracture. The initial surgical intervention involved the use of hybrid external skeletal fixation (ESF) to stabilize the radial head, concomitant with the application of a composite of bone morphogenetic protein type 2 (BMP-2)-loaded hydroxyapatite and gelatin microparticles at the fracture site. Although successful radial head healing was achieved, the ESF pinholes caused a defect in the proximal ulnar diaphysis. Subsequently, the ESF was removed, and a locking plate was applied in conjunction with the BMP-2-loaded collagen membrane to correct the radius defect. Clinical follow-up at 4.8 years postoperatively revealed a mildly decreased range of motion of the affected elbow joint, but no clinical symptoms such as lameness. Radiography revealed minimal degenerative changes and a radioulnar synostosis. Computed tomography revealed differences in the leg length and bone density. Gait analysis revealed that the left forelimb had a significant improvement in weight-bearing capacity based on weight distribution–peak vertical force metrics, compared with the right forelimb. Based on clinical outcomes, the combined application of hybrid ESF and bone tissue engineering techniques can be considered a feasible alternative treatment for radial head fractures. [ABSTRACT FROM AUTHOR]

Background: Our study aimed to evaluate the clinical and radiologic results of all-arthroscopic treatment of terrible triad injuries followed-up for a minimum of 5 years and investigate how arthroscopic partial excision for radial head fractures affects the results at the final follow-up. Methods: We retrospectively reviewed consecutive patients with terrible triad injuries who underwent all-arthroscopic treatment between January 2011 and June 2018. In group I, we performed conservative or arthroscopic fixation of stable radial head fractures, while in group II, arthroscopic partial excision of unstable radial head fractures involving <30%–50% of the articular surface area was performed. Clinical outcomes were measured by visual analog scale score and assessment of instability, range of motion (ROM), and Mayo Elbow Performance Score. Radiological outcomes were evaluated using x-rays, and the integrity of the repaired lateral collateral ligament complex was confirmed through magnetic resonance imaging. Results: Thirty-two patients with an average age of 49.5±16.2 years met the inclusion criteria and were followed-up for a mean of 82.7±22.2 months. Twenty patients were assigned to group I and 12 patients to group II. Clinical outcomes showed no significant differences between the two groups at the final follow-up (P>0.05). On radiological evaluation, more heterotopic ossifications were found in the radial head excision group (group II, 66.7% vs. group I, 35%; P=0.02); however, there was no significant difference in ROM between the two groups (P>0.05). Conclusions: In all-arthroscopic treatment of terrible triad injuries, arthroscopic partial excision of the radial head did not seem to have a significant impact on elbow joint stability. Level of evidence: III. [ABSTRACT FROM AUTHOR]

An improved understanding of complex solute transport processes in a single fracture is the foundation for advancing fracture network research. This study addresses a radial reactive transport problem in a fractured rock matrix system, with an emphasis on the role of non-equilibrium sorption. A new model that integrates a two-site nonequilibrium sorption framework was developed in a single fracture under a radial flow condition. Semianalytical models were derived utilizing Laplace transform techniques. These solutions offer insights into the spatio-temporal concentration, back diffusion and diffusive mass flux issues. When benchmarked against prior solutions, the approach presented here demonstrates superior accuracy and robustness. Several significant results were obtained. First, nonequilibrium sorption leads to a more pronounced peak in the breakthrough curves (BTCs) and diminishes the tailing of BTCs in the system. Second, a higher degradation rate for nonequilibrium sorption reduces the concentration of BTCs in the later stage but has minimal impact in the early stage. Third, after clean water injection, the back diffusion from the rock matrices into the fracture was observed, predominantly near the wellbore, accounting for the tailing behavior. Meanwhile, the diffusive mass flux exhibits a sharp rise and then declines in the early stages. Finally, an increased proportion of equilibrium sorption in the fracture leads to a decrease in the diffusive mass flux, whereas it displays the inverse trend in the rock matrix. In general, these findings underscore the essential role of nonequilibrium sorption considerations for the accurate representation of solute transport processes in fractured rock matrix systems. [ABSTRACT FROM AUTHOR]

Objective: To assess the reliability and reproducibility of AO/OTA, Frykman and Fernandez classification systems for distal radius fractures on CT. Materials and methods: Four radiologists, including one radiology resident, two musculoskeletal radiology fellows and one radiology consultant independently evaluated CT scans of 115 patients with distal radius fractures and classified the fractures according to AO/OTA, Frykman and Fernandez classification system. To assess reproducibility, a second set of reading was done by two observers after an interval of six weeks. Interobserver reliability was calculated for each classification system using intraclass correlation coefficient (ICC) and using Light's modification of kappa. Intraobserver agreement was calculated using Cohen's kappa. Results: Interobserver reliability using ICC showed fair agreement for AO/OTA (0.447) and Frykman (0.432) classification system and poor agreement for Fernandez (0.196) classification system. Interobserver agreement using kappa was moderate for AO/OTA fracture (0.447) classification into either of three types, while it was only slight for complete classification into type, group and subgroup (0.177). Interobserver agreement using kappa was slight for Fernandez (0.196) classification systems and moderate for Frykman classification system (0.406). Intraobserver agreement for AO/OTA classification system was moderate for observer 1 (0.449) and slight for observer 2 (0.162). Intraobserver agreement for Frykman classification system was substantial for observer 1(0.754) and moderate for observer 2 (0.496). Intraobserver agreement for Fernandez classification system was moderate for both the observers (0.333, 0.320). Conclusion: Currently there is no classification system that is fully reproducible. AO/OTA and Frykman classification systems performed better than Fernandez classification system in terms of interobserver reliability. However, Frykman classification system performed better than both AO/OTA and Fernandez classification system in terms of intraobserver reproducibility. Fernandez classification system had worst inter and intraobserver reliability in present study. Reliability and reproducibility of AO/OTA classification system decreased when fractures were divided into subgroups. [ABSTRACT FROM AUTHOR]