The Yale journal of biology and medicine
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When closed manipulation fails to restore articular congruity in comminuted, displaced fractures of the distal radius, open reduction and internal fixation is required. Results of surgical stabilization and articular reconstruction of these injuries are reviewed in this retrospective study of 49 patients with 52 displaced, intra-articular distal radius fractures. Forty-three patients (87%) with a mean age of 37 years (range of 17 to 79 years) were available for evaluation. ⋯ The Injury Score System presented here, and in particular the number of fracture fragments, correlated most closely with outcome of all the classification systems studied. Operative treatment of these distal radius fractures with reconstruction of the articular congruity and correction of the articular surface alignment with internal fixation and/or external fixation, can significantly improve the radiographic alignment and functional outcome. Furthermore, the degree to which articular stepoff, gap between fragments, and radial shortening are improved by surgery is strongly correlated with improved outcome, even when the results are corrected for severity of initial injury, whereas correction of radial tilt or dorsal tilt did not correlate with improved outcome.
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A Ligament of Struthers has been identified and studied in a cadaveric arm. Its relationships to a rudimentary supracondylar process, the pronator teres muscle, the median nerve, and the medial epicondyle of the humerus are described. Compared to an extensively studied series of normals, the ligament in this case was associated with abnormally proximal branching of the median nerve, a finding which is surgically significant and not addressed in the literature to date.