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Die vorliegende Arbeit befasst sich mit therapierelevanten Faktoren bei distalen Radiusfrakturen. Auf der Grundlage der nach AO klassifizierten, distalen Radiusfrakturen werden sowohl verletzungsbedingte, als auch therapiebedingte Einflußfaktoren hinsichtlich des klinisch-radiologischen Ergebnisses untersucht. Es erfolgt die Darstellung der Komplikationshäufigkeit bei operativ und konservativ versorgten distalen Radiusfrakturen. Diese wird in Zusammenhang mit unfall-und patientenbezogenen Faktoren, Begleitverletzungen und therapiebezogenen Einflußfaktoren untersucht und am klinisch-radiologischen Ergebnis gemessen. Zur Objektivierung der klinisch-radiologischen Nachuntersuchung dienen der DASH-Score, der Gartland und Werley-Score (modifiziert nach Sarmiento) und der Stewart Score.

Distal radius fractures are the single most common type of fracture suffered among the adult population. Presently, clinical decision making regarding optimal treatment is inconclusive. The goal of this thesis was to design, develop, and biomechanically test a novel implant for the stabilization of distal radius fractures. The novel implant is intended to provide a minimally invasive, low cost alternative to locked volar plates, while still permitting an earlier return to function. The implant consists of an angled bar with a sharp cutting edge and is inserted using a minimally invasive approach through the radial styloid. Surgical instrumentation was designed to facilitate the procedure in a controlled manner. To determine whether the implant would be capable of providing an early return to function, biomechanical tests were conducted both experimentally and numerically. Biomechanical testing showed that mechanical fixation with the novel implant does not support and early return to function.

Purpose: To evaluate the course of recovery in fall-risk and functional status over the first year following a distal radius fracture (DRF), and evaluate differences in fall and fracture risk factors in women over the age of 50 years with a DRF compared to their non-fractured peers. Methods: Two cohorts of participants volunteered in two sub-studies of the thesis. The first was seventy-eight women recruited from a DRF Clinic within the first week after their fracture, and followed up in concert with standard clinic appointments at week three, nine, 12, 26, and 52 post-fracture. The second cohort consisted of women aged 50 years or older, with and without a recent distal radius fracture, being at least 6 months post-DRF, but no more than 2 years post-fracture. Seventy-seven women age 50-78 with (Fx, n = 32) and without (NFx = 45) a history of DRF were assessed on two occasions within 4 weeks apart using a battery of fall and fracture risk tools, including balance, mobility, gait speed, fracture risk assessment, as well as bone quality assessment using peripheral quantitative computer tomography (pQCT) and dual x-ray absorptiometry (DXA). Results: Fall-risk status (strength, balance, mobility) gradually improved over the first year post-fracture, with balance confidence remaining high even immediately post-fracture. In the second study, women with a recent DRF, compared to women without, demonstrated higher fall and fracture risk. Women with a recent DRF had lower bone and muscle strength in both the upper and lower extremities compared to the non-fractured controls, with no differences in DXA derived aBMD at the femoral neck or spine. Significance of findings: The results of these studies will help clinicians understand the normal course of functional recovery post-fracture, and assist in determining appropriate fall risk assessment and interventions for post-menopausal women at risk of fragility fracture. Results demonstrate the importance of studying women at risk of DRF as an important first indicator of bone fragility and risk of future fracture. These findings also strengthen the notion that DXA alone may not be the best predictor for fracture risk.

Stipinkaulio lūžiai – tai vieni iš dažniausiai pasitaikančių lūžių suaugusiems. Šie lūžiai sudaro 10-15% visų lūžių. Nustatyta, kad per visą gyvenimą iš dešimties maždaug du ��monės patiria lūžius. Dėl lūžio sutrinka pirštų, plaštakos, dilbio ir iš dalies – visos rankos judėjimo funkcija. Šio darbo tikslas – įvertinti ergoterapijos poveikį ligoniams, patyrusiems stipinkaulio lūžį. Darbo uždaviniai: 1. Įvertinti plaštakos funkciją ligoniams, patyrusiems stipinkaulio lūžį, 2. Įvertinti ligonių savarankiškumą patyrus stipinkaulio lūžį, 3. Įvertinti ergoterapijos poveikį šių ligonių rankos funkcijos ir savarankiškumo pagerinimui. Tyrimas buvo atliktas Všį Kauno Kalniečių poliklinika. Tirti asmenys, patyrę stipinkaulio lūžius. Tyrime dalyvavo 100 ligonių. Ligoniai buvo suskirstyti į dvi grupes: pirmą ir antrą po 50 ligonių. Pirmą grupę sudarė ligoniai, patyrę dešinės rankos stipinkaulio lūžį. Antrą – ligoniai, patyrę kairės rankos stipinkaulio lūžį. Abiejų grupių ligoniams buvo sudaryta ir taikyta individuali ergoterapijos programa, atsižvelgiant į rankos funkcijos ir savarankiškumo sutrikimą. Ergoterapijos poveikiui įvertinti buvo naudojama: šiam tyrimui paruoštas klausimynas, plaštakos jėgos matavimas dinamometru, plaštakos funkcijos matavimas goniometru, skausmo ir sustingimo vertinimas, funkcinis judėjimo testas (Modifikuotas Keitelio indeksas), funkcinio nepriklausomumo testas (FNT). Tyrimo išvados: 1.Įvertinus plaštakos funkciją ligoniams, patyrusiems stipinkaulio lūžį, buvo... [toliau žr. visą tekstą] / Radius fractures – are one of the most likely to occur fractures for adults. From all fractures they include from 10 to 15 % of all fractures. It is examined that through whole life, two persons of ten sustain these fractures. Due to fracture fingers, hand, forearms and in part – whole hands, function becomes irregular. Aim of this work is to estimate occupational therapy influence to patients, experienced radius fracture. Tasks of this work is: 1. Evaluate patients hand function, who are experienced spoke-bone fracture, 2. Evaluate patients independence after this fracture, 3. Evaluate occupational therapy effect to these patients hand function and self-care improvement. Research was made at Všį Kauno Kalniečių clinic. Examined people had radius fracture. There were analyzed hundred patients. They were separated into two groups: first and second, both with 50 patients. First group patients had right hand spoke-bone fracture. Second – patients with left hand spoke-bone fracture. To all patients from both groups was adjusted and applied individual occupational therapy programs considering their hand function and autonomy disorder. In order to estimate impact of occupational therapy was used: specially for this research prepared questionnaire; hand strength was measured with dynamometer; hand function was measured with goniometer; also it was evaluated pain and rigor; patients were examined with function movement test (Modified Keitel index) and functional independence... [to full text]

Distal radius fracture (DRF) is one of the most common fall-related osteoporotic (OP) fracture and is an early predictor of subsequent falls and OP fractures among people with DRF. The majority of older people with DRF present with low bone mineral density (BMD) and there is often transition to reduced muscle strength, poor balance, fear of falling and physically inactive lifestyle after fall-related DRF. This thesis consists of three manuscripts which are aimed to explore the recovery patterns and the role of modifiable risk factors in predicting subsequent falls, OP fractures and BMD in patients with DRF. The first manuscript explores the recovery patterns in modifiable risk factors for falls and OP fractures over four years in patients with DRF. Our study findings showed that patients with DRF experienced both short-term (6 months) and long-term (4 years) improvement in fracture specific pain/disability, physical activity, fear of falling, BMD and general health status; although the majority of the recovery was achieved at six months after DRF. The second manuscript is a cross-sectional study identifying modifiable risk factors for BMD in patients with DRF. The unaffected hand grip strength was identified as the independent predictor of BMD explaining 17% and 12% of total variability in the BMD-femoral neck and BMD-total hip, respectively. Among age-stratified women with DRF, balance and unaffected hand grip strength were identified as independent determinants of BMD explaining 10% and 32% of the total variability in BMD-femoral neck among 50-64 year and 65-80 year old, respectively. The third manuscript is a longitudinal study identifying modifiable risk factors for subsequent falls and OP fractures at four years after DRF. The results suggest that nearly 24% of patients reported one or more subsequent falls (in the last six months) and 19% of patients experienced at least one subsequent OP fracture after DRF. Patients with poor balance, low BMD, fracture specific pain/disability of >81 points on patient-rated wrist evaluation questionnaire and presence of a prior history of multiple falls (≥2) had three times higher odds of subsequent falls. When adjusted for BMD, age and gender, only prior falls was identified as a significant independent predictor of subsequent falls. We were not fully powered to explore association of various modifiable and non-modifiable risk factors with subsequent fractures. However, we found that patients with osteopenia or osteoporosis had clinically four times higher odds of subsequent OP fractures than patients with normal BMD. / Thesis / Doctor of Philosophy (PhD) / Wrist fractures are the most common fall-related fragility fractures and often an early indicator of future falls and fractures. This thesis project described recovery patterns in various risk-factors at 4-years after wrist fracture and explored their association with bone mineral density (BMD) and subsequent falls and fractures. We found that the majority of recovery in fracture-specific pain/disability, fear of falling and health-status takes place within six months, although small changes were also noted between 6 months-4 years. People with low unaffected hand grip-strength might have low BMD. Furthermore, people with poor balance, greater fracture-specific pain/disability, osteopenia or osteoporosis and a prior history of multiple falls (≥2) had nearly 3 times higher odds of secondary falls and those with osteopenia or osteoporosis had 4 times higher odds of a secondary fracture. We believe this information will help therapists/clinicians to identify people at risk of future falls/fractures and offer preventive services.

<p>Some individuals remain at risk for adverse outcomes such as chronic wrist/hand pain, falls, and fall-related osteoporotic fractures after distal radius fracture (DRF) remain. This thesis includes five studies that were conducted to establish prediction rules for assessing the risk of these adverse outcomes following DRF.</p> <p>The first manuscript outlines a theoretical framework (RACE - <strong>R</strong>educing pain, <strong>A</strong>ctivating, <strong>C</strong>ognitive reshaping, <strong>E</strong>mpowering) for managing the risk of adverse outcomes, mainly chronic pain, in individuals with DRF. The RACE is one of the first frameworks to suggest a risk-based management approach for individuals with DRF.</p> <p>The Patient-Rated Wrist Evaluation (PRWE) is a condition-specific measure for DRF used in research as well as clinical practice to measure pain and functions in individuals with different wrist/hand injuries. The second manuscript contributes to the literature by providing the first systematic literature review that synthesizes the evidence regarding the psychometric properties of the PRWE. The review determined that the PRWE has excellent reliability, construct validity, and responsiveness in individuals with DRF.</p> <p>The third manuscript indicates that the baseline pain intensity is an independent predictor of chronic pain in individuals with DRF. The results also suggest that the individuals who score ≥35/50 on the pain scale of the PRWE at baseline have 8 times greater risk for developing chronic wrist/hand pain compared to those who score < 35/50.</p> <p>The fourth and fifth manuscripts describe results of a two step study. The fourth manuscript is a structured literature synthesis that identified suitable measures for predicting the risk of falls and fall-related osteoporotic fractures following DRF. The fifth manuscript summarizes the results of preliminary analysis of psychometric properties of selected fall risk measures identified in the fourth manuscript. The fifth manuscript also provides feasibility and sample size requirements for conducting a fall prevention trial in individuals with DRF.</p> / Doctor of Philosophy (PhD)

Distal radius fracture (DRF) is the most common fracture encountered in clinical practice. Every year, more than 20000 people in Sweden suffer from this injury. It has been shown that there is a correlation between malalignment and function following distal radial fractures and malunion may cause persistent pain and disability. A problem has been in making a correct initial assessment of the fracture. Many fractures are unstable despite an acceptable position on the initial radiographic examination or following a successful closed fracture reduction. Numerous classification systems have been developed for evaluation of DRF in order to predict the outcome. However, the values of these are limited since they have not shown satisfactory reliability. Furthermore, the utility of these systems to predict radiographic or clinical outcome is not yet proven. These shortcomings may be one reason why optimal DRF management is still controversial. Requests for a new classification system of DRF, predictive of outcome and easy to use, have been made. Improvement in initial assessment of DRF will benefit a large group of patients, as well as the society, by reducing persistent symptoms and disability. Study I: In this study we evaluated the interobserver and intraobserver reliability of a new classification system (the Buttazzoni classification). Two hundred and thirty-two patients with acute DRF were blindly evaluated using the new classification by three orthopaedic surgeons twice with a 1-year interval. The new classification showed fair to substantial interobserver and intraobserver reliability, i.e., results comparable with other commonly used classification systems. Study II: This was a prospective multicenter study of fracture stability in 428 DRF. The study investigated whether cortical comminution and intra-articular involvement, as well as the new classification system, could predict displacement in DRF. Logistic regression analysis showed that initial position of the fracture and volar or dorsal comminution predicted later displacement, while intra-articular involvement did not. Volar comminution was the strongest predictor of displacement. The new classification system, which is the first to include volar comminution as a separate parameter, was highly predictive of fracture instability. Furthermore we found that it is quite common for non-operatively treated fractures to displace at a later stage than two weeks. Study IV: In study II it was found that late displacement of DRF, still in acceptable radiologic position after 10-14 days, occurred in approximately 1/3 of cases. Despite this, we have not been able to find any study focusing on evaluating the clinical outcome in patients with late displacement. Two hundred and nine unilateral DRF from study II were still in good position after 10-14 days and were included in the study. One hundred and seventy five patients had radiographs taken at a minimum of 3 months and a clinical examination 1 year after the fracture. Late displaced distal radius fractures had significantly higher loss of ROM and grip strength compared to fractures that didn’t displace. No significant differences were seen in subjective outcome. In conclusion, initial position of the fracture predicted later displacement and was the most important parameter in predicting clinical outcome. Comminution of the fracture also affected radiological stability and clinical outcome. Volar comminuted fractures are highly unstable and need surgical intervention if displacement is to be avoided. Intra-articular involvement affected clinical outcome. Late displacement is common in DRF and may result in loss of range of motion and grip strength. To detect late displacement, DRF should be followed for more than 2 weeks. The new classification system had a moderate reliability and reproducibility. The classification was found predictive of radiologic and objective clinical outcome. However, it was not predictive of subjective outcome. The classification system was also predictive of fractures at risk for late displacement.

Stipinkaulio distalinio galo lūžiai (SDGL) yra vienas dažniausių kaulų ir raumenų sužalojimų, sudarantys apie 3 proc. visų rankos sužeidimų. Lietuvoje, Sveidros duomenimis, 2010 m. dėl SDGL hospitalizuoti 1375 pacientai (986 moterys ir 389 vyrai). Vyrų traumų skaičiaus nei didėjimo, nei mažėjimo tendencijos nėra. Moterų traumų nuo 50–55 m. skaičius padvigubėja (47 iki 99). Vyresnių moterų SDGL patogenezės pagrindas gali būti osteoporozė. Tyrimo tikslas: Įvertinti kinezioteipavimo poveikį pacientams po tolimojo stipinkaulio galo lūžių. Tyrimo uždaviniai: 1. Įvertinti pacientų rankos funkciją ir savarankiškumą prieš ergoterapiją ir po jos taikant kinezioteipavimą; 2. Įvertinti pacientų rankos funkciją ir savarankiškumą prieš ergoterapiją ir po jos be kinezioteipavimo; 3. Palyginti ergoterapijos efektyvumą taikant kinezioteipavimą; Tyrimas buvo atliktas 2013 metų spalio – kovo mėnesiais. Ištirti 32 pacientai, patyrę tolimojo stipinkaulio galo lūžius, Viešosios įstaigos „Kauno klinikinėje ligoninėje“ bei „Kauno klinikos“, reabilitacijos skyriuje, gydyti ambulatoriškai. Pacientai buvo suskirstyti į dvi grupes: kontrolinę ir tiriamąją. Kontrolinę grupę sudarė pacientai, kuriems taikyta ergoterapija be kinezioteipavimo. Tiriamąją grupę sudarė pacientai, kuriems taikyta ergoterapija ir kinezioteipavimas. Abiejų grupių pacientams buvo sudaryta ir taikyta individuali ergoterapijos programa, atsižvelgiant į rankos funkcijos ir savarankiškumo sutrikimą. Ergoterapijos programos ir... [toliau žr. visą tekstą] / Distal radius fractures are among the most common musculoskeletal injuries. It consists about 3% of all hand injuries. In Lithuania 1375 patients were hospitalized in 2010 year. Men injury rate has unchanged. Women injuries rate from 50-55 has doubled. Aim of work was to estimate occupational therapy and kinesio taping influence to patients, experienced radius fractures. Tasks of this work were: 1. Evaluate patients hand function and independence before and after occupational therapy through kinesio taping. 2. Evaluate patients hand function and independence before and after occupational therapy using kinesio taping. 3. Compare the effectiveness of occupational therapy through kinesio taping. Research was conducted in October 2013 – March to examine the 32 patients experienced distal radius fractures at Kaunas Clinical hospital and Kaunas clinics in rehabilitation department. Patients were divided into two groups: control and study. The control group consisted of patients who received occupational therapy without kinesio taping. The study group consisted of patients who received occupational therapy through kinesio taping. The individual occupational therapy program were formed and applied for both groups of patients according to the hand function and self – independence. For occupational therapy program to evaluate the effectiveness of kinesio taping were used: specially for this research prepared questionnaire; hand strength was measured with dynamometer; functional range... [to full text]

Stipinkaulio distalinės dalies lūžiai yra vienas iš dažniausių kaulų ir raumenų sistemos pažeidimų. Literatūroje nurodoma, kad distalinės stipinkaulio dalies lūžiai yra 1/10 visų lūžių, kuriuos patiria vyresni nei 35 metų amžiaus asmenys. Apie 3 % pacientų, po šios traumos išlieka ilgalaikė negalia. Siekiant optimizuoti stipinkaulio distalinės dalies lūžių gydymą, buvo atliktas tyrimas, kuriame buvo iškelti trys uždaviniai. Vertinome 2 savaičių imobilizacijos įtaką rankos funkcijai, po stipinkaulio distalinės dalies lūžio ir osteosintezės delnine rakinama plokštele. Taip pat vertinome,radiologinio lūžio tipo, pagal AO klasifikaciją, įtaką rankos funkcijai. Sugijus kaului, tirta metalinių konstrukcijų pašalinimo įtaka rankos funkcijai. Vertinant rezultatus, nustatyta, kad riešo judesių amplitudė ir rankos funkcija tarp pacientų, patyrusių stipinkaulio distalinės dalies lūžį su poslinkiu ir operuotų delnine rakinama plokštele, kuriems buvo taikyta pooperacinė 2 savaičių riešo imobilizacija ir kuriems pooperacinė riešo imobilizacija nebuvo taikyta, nesiskyrė. Tiriamiesiems, patyrusiems C tipo lūžį pagal AO radiologinę klasifikaciją nustatyta prastesnė funkcija. Riešo judesių amplitudė ir rankos funkcija po delninės rakinamos plokštelės pašalinimo nepakito. / Distal radius fracture is one of the most common injuries of the skeletal and muscular system. It has been reported in literature that distal radius fractures account for one-tenth of all the fractures experienced by people older than 35 years. Long-term disability remains in approximately 3% of patients after a distal radius fracture. In order to optimise treatment of distal radius fractures, a study with three objectives was performed. We evaluated the effect of immobilisation for the period of 2 weeks on the hand function after a distal radius fracture and osteosynthesis with a volar locking plate. The effect of the fracture type according to the AO classification on the hand function was also assessed. After the bone has healed, the effect of the removal of metal constructions on the hand function was evaluated. The analysis of the results demonstrated that there were no differences in the range of wrist motions and the hand functionbetween the patients after a displaced distal radius fracture operated with a volar locking plate and post-surgery immobilisation of the wrist applied for the period of 2 weeks and the patients who did not have post-surgery wrist immobilisation applied. A worse function was determined in the patients after type C fracture according to the AO radiological classification. The range of wrist motions and the hand function after the removal of a volar locking plate did not differ.