1/41. Manipulative management of post-colles' fracture weakness and diminished active range of motion. OBJECTIVE: To discuss the management of a patient with wrist weakness and a diminution in active range of motion resulting from colles' fracture. CLINICAL FEATURES: A 58-year-old woman complained of persistent loss of grip strength and mobility in her right wrist. These complaints were from colles' fracture occurring 19 months before initiation of care. Dynamometer and goniometric testing revealed significant loss of grip strength and range of motion compared with the uninvolved, nondominant wrist. INTERVENTION AND OUTCOME: Specific joint manipulation for improvement in mobility and grip strength of the wrist was performed. The patient's right wrist was evaluated for grip strength and active range of motion over a 3-week period, providing a baseline of function before treatment. After 4 visits of baseline measurements, a series of 4 treatments and 4 reevaluations was performed. The patient exhibited a significant increase in grip strength and active range of motion. CONCLUSION: Appropriate intervention of chiropractic manipulation and examination procedures culminated in a successful resolution of this case. When such cases are recognized, appropriate management may occur conservatively with judicious application of joint manipulation and reevaluation procedures. ( info) |
2/41. Telemedical experiences at an Antarctic station. Wintering-over in Antarctica represents a physician's most remote and inaccessible scenario, apart from a space station. Because of the harsh and unpredictable winter weather, Antarctic stations are typically inaccessible for over six months of the year. telephone and fax communication, and recently other forms of telemedicine, have provided vital links to specialists. The author was the sole physician for more than 250 people wintering-over during the 1995 austral winter at McMurdo Station. There were several instances of serious or life-threatening illness where the author relied on teleconsultation. These cases included new-onset coronary artery disease, posterior hip dislocation, complicated colles' fracture and acute appendicitis. There were also numerous consultations for non-emergency clinical presentations normally managed by specialists. telemedicine was a crucial link to specialists from the remote and inaccessible environment of Antarctica. ( info) |
3/41. Change in bone mass after colles' fracture: a case report on unique data collection and long-term implications. The cast immobilization of a fractured limb results in a loss of bone mass; however, the long-term implications of that effect with regard to bone mineral status, particularly in other skeletal sites, are less known. The purpose of this study was to describe changes in bone mass in different skeletal sites triggered by colles' fracture. The case is unique regarding the existence of baseline measurements taken just a few days before the fracture on all measurable skeletal sites, including the fractured radius. Therefore, it was also possible to determine whether the injury caused long-term bone loss in the affected and unaffected skeletal sites. The patient was a healthy, premenopausal Caucasian woman, in her late forties, who fractured her nondominant wrist as a result of low-impact fall on ice. The arm and the metacarpals were immobilized to the elbow for 5 wk. Bone mass measurements were performed with DPX-MD densitometer (Lunar Corp. Madison, WI) at baseline and 5, 10, 13, 21, and 52 wk postinjury. At the 5-wk measurement (on plaster removal) there was a notable increase in bone mineral density (BMD) and bone mineral content (BMC) in all sites of ulna and radius of the injured forearm (from 10 to 73%), followed by the apparent decline to or below the baseline at 10, 13, 21 and 52 wk of follow-up. Other skeletal sites were measured at 10 wk when a substantial decrease in BMD and BMC in some of the hip regions and lumbar spine was noticed; most notably in L3-L4, Ward's triangle, and femoral neck (from 2 to 8%) and remained such after 1 yr. Although this patient had a normal bone mineral status and no osteopenia detected before fracture, the trauma of radial fracture caused long-standing bone loss in fracture-prone areas-hip and spine. Because about 70% of bone strength is explained by its mineral density, the patient might be at increased risk for fracture later in life. The changes in bone mass after injury should be monitored and interpreted carefully, and more elaborate treatment of patients presenting with wrist fractures are needed to prevent any potential risk for later osteoporotic fractures in spine and hip and possible refracture of the injured extremity. ( info) |
| osteoporosis, a disease characterized by low bone mass, microarchitectural deterioration of bone, and susceptibility to bone fractures, can lead to debilitating pain and deformity. The disease represents a major health problem, particularly in older women. Approximately 1.5 million people in the united states suffer osteoporosis-related fractures annually, and many never gain full recovery. The direct annual health expenditures related to osteoporosis fractures were estimated at $13.3 billion in 1994, but quality of life costs related to osteoporosis are even more profound. Identifying people at risk for osteoporosis and early treatment can minimize its destructive effects. nurses play an important role in the development of strategies to reduce the incidence of osteoporosis and osteoporosis-related fractures, pain, and deformity to help older adults lead healthy, productive lives in their later years. ( info) |
| Flexor tendon rupture as a complication of colles' fracture is rare. We describe a case of attrition rupture of flexor tendons to the ring and little fingers after a malunited colles' fracture, and we review the 17 previously reported cases. ( info) |
| Delayed carpal tunnel syndrome is rare. We describe the electrophysiological findings in a patient with Colle's fracture, who developed carpal tunnel syndrome 22 years after a wrist injury. ( info) |
7/41. Early corrective osteotomy for a malunited colles' fracture using volar approach and calcium phosphate bone cement: a case report. We report a case of malunion of the distal radius after a colles' fracture treated with osteotomy using a volar approach combined with calcium phosphate bone cement grafting of the dorsal defect via a drill hole from the volar cortex 6 weeks after the injury. One year and 4 months after surgery range of motion and grip strength were improved and x-rays of the wrist showed complete union of the distal radius with progressive absorption of the calcium phosphate bone cement. ( info) |
| Nine cases of acute carpal tunnel syndrome are reported. Etiologies include: bleeding secondary to chronic lymphatic leukemia; colles' fracture of the wrist (2 cases); Epiphyseal fracture (Salter II) of the distal radius; Bleeding secondary to giant cell tumor of the tendon sheath; Unstable distal radio-ulnar joint; Displaced intra-articular fracture of the distal radius; Rheumatoid synovitis and vasculitis; Trans-scaphoid, perilunar fracture dislocation of the wrist. Early recognition of median nerve compression in the carpal tunnel is vital. The signs of median nerve compression should be looked for in all cases of wrist trauma. In our opinion, immediate surgical decompression is frequently indicated. ( info) |
9/41. Bony transfixion of the median nerve following colles' fracture. A case report. Reported herein is the case of a 45-year-old man with a colles' fracture complicated by median nerve transfixion by a bony spike. This seems not to have been reported previously and reinforces the belief that early median nerve exploration should be performed if there is nerve dysfunction associated with a volar bony spike on the postreduction roentgenograms. ( info) |
10/41. Irreducible skin penetration of the ulnar head in Colles fracture--case report. Three cases out of four of skin penetration by the ulnar head associated with Colles fractures were found to be irreducible. On exploration they had identical pathologic anatomy, viz, buttonholing of the ulnar head between the flexor carpi ulnaris, flexor digitorum profundus, pronator quadratus, and the flexor retinaculum. Incising the flexor retinaculum facilitated reduction. ( info) |