Forearm Fractures in Children

__Abstract__ The forearm consists of the radius and ulna which are connected by the proximal and distal radioulnar joints, the interosseous membrane and several muscles. Forearm rotation, consisting of pronation and supination, is a rotatory motion of the radius around the ulna in combination with subtle translation1. The longitudinal axis of the forearm is considered to pass through the centre of the radial head proximally and through the ulnar fovea at the base of the ulnar styloid distally2. Forearm rotation is commonly used in daily life; whereas pronation is used for writing and typing, movements such as perineal hygiene and accepting monetary change require supination. In children up to the age of 15 years, pronation of 50-80 degrees and supination of 80-120 degrees are considered normal3. Furthermore a limitation of forearm rotation only affects daily activities if pronation or supination is less than 50 degrees4, because the ipsilateral shoulder can compensate mild limitation of pronation by abduction and internal rotation, and mild limitation of supination by adduction and external rotation. In a number of pathologies forearm rotation can be limited, such as following a forearm fracture. Forearm fractures represent one of the most common fractures in children; a distinction is made between fractures of the radius or the ulna only, and fractures of both the radius and ulna. Furthermore, a differentiation is made between incomplete fractures typical for children (torus, greenstick and bowing) and complete fractures that occur in children as well as in adults. The treatment of these both-bone forearm fractures depends on anatomical location (proximal metaphysis, distal metaphysis or diaphysis) and fracture displacement (minimally displaced or severely displaced)

Corrective Osteotomy in a Patient With Congenital Absence of Pronation Based on Three-Dimensional Statistical Shape Modeling

We present a new indication of a three-dimensional statistical shape model (SSM): a patient with bilateral impaired forearm rotation due to a congenital variance in bone shape. A corrective osteotomy was planned and performed to best match the SSM created by computed tomography (CT) scans of 18 peers. Postoperatively, pronation increased by 70°, and the patient was pain-free. A CT scan showed accurate correction of the deformity and union of all osteotomies. This technique offers opportunities for patients with bilateral nontraumatic osseous forearm pathology.</p

Uitlaatgaskatalysatoren voor auto's

Hoewel de fiets als personen vervoermiddel om uiteenlopende redenen te prefereren is boven de bromfiets of de auto, kiezen (helaas) veel leerlingen voor gemotoriseerd vervoer. Zo gauw ze de 16 jaar gepasseerd zijn, schaffen zij zich een brommer aan en na hun achttiende verjaardag proberen zij zo snel mogelijk een rijbewijs te bemachtigen, ondanks de negatieve geluiden over autogebruik zoals filevorming, verkeersonveiligheid en milieuvervuiling. Wat het laatste betreft wordt in dit artikel ingegaan op de uitlaatgaskataIysator voor auto's met de bijbehorende milieutechnologische, chemische en fysische aspecten. Dit onderwerp is ons inziens interessant en relevant voor leerlingen in de vrije ruimte van Biologie/Natuurkunde/ Scheikunde in de tweede fase van het voortgezet onderwijs

Normative ultrasound values for Achilles tendon thickness in the general population and patients with Achilles tendinopathy:A large international cross-sectional study

The objective of the study was to obtain adjusted ultrasonographic reference values of the Achilles tendon thickness (maximum anterior–posterior distance) in adults without (previous) Achilles tendinopathy (AT) and to compare these reference values with AT patients. Six hundred participants were consecutively included, comprising 500 asymptomatic individuals and 100 patients with clinically diagnosed chronic AT. The maximum tendon thickness was assessed using Ultrasound Tissue Characterization. A multiple quantile regression model was developed, incorporating covariates (personal characteristics) that were found to have a significant impact on the maximum anterior–posterior distance of the Achilles tendon. A 95% reference interval (RI) was derived (50th, 2.5th-97.5th percentile). In asymptomatic participants median (95% RI) tendon thickness was 4.9 (3.8–6.9) mm for the midportion region and 3.7 (2.8–4.8) mm for the insertional region. Age, height, body mass index, and sex had a significant correlation with maximum tendon thickness. Median tendon thickness for the midportion region was calculated with the normative equation −2.1 + AGE × 0.021 + HEIGHT × 0.032+ BMI × 0.028 + SEX × 0.05. For the insertional region, the normative equation was −0.34 + AGE × 0.010+ HEIGHT × 0.018 + BMI × 0.022 + SEX × −0.05. In the equations, SEX is defined as 0 for males and 1 for females. Mean (95% CI) difference in tendon thickness compared to AT patients was 2.7 mm (2.3–3.2, p &lt; 0.001) for the midportion and 1.4 mm (1.1–1.7, p &lt; 0.001) for the insertional region. Compared to the asymptomatic population 73/100 (73%) AT patients exhibited increased tendon thickening, with values exceeding the 95% RI. This study presents novel reference values for the thickness of midportion and insertional region of the Achilles tendon, which were adjusted for personal characteristics. Our novel web-based openly accessible calculator for determining normative Achilles tendon thickness (www.achillestendontool.com) will be a useful resource in the diagnostic process. Trial registration number: This trial is registered in the Netherlands Trial Register (NL9010).</p

The evolution of hand function during remodelling in nonreduced angulated paediatric forearm fractures:a prospective cohort study

Forearm fractures are very common orthopaedic injuries in children. Most of these fractures are forgiving due to the unique and excellent remodelling capacity of the juvenile skeleton. However, significant evidence stating the limits of acceptable angulations and taking functional outcome into consideration is scarce. The aim of this study is, therefore, to get a first impression of the remodelling capacity in nonreduced paediatric forearm fractures based on radiological and functional outcome. Children aged 0-14 years with a traumatic angular deformation of the radius or both the radius and ulna, treated conservatively without reduction, were included in this prospective cohort study. Radiographs were taken and functional outcome was assessed at five fixed follow-up appointments throughout a period of one year. Outcome measurements comprised radiographic angular alignment, grip strength and wrist mobility. A total of 26 children (aged 3-13 years) with a traumatic angulation of the forearm were included. Mean dorsal angulation at the time of presentation amounted to 12° (5-18) and diminished after one year to a mean angulation of 4° (0-13). Grip strength, pronation and supination were significantly diminished compared to the unaffected hand up to 6 months after injury. After one year, no significant differences in function between the affected and the unaffected arm were found. Nonreduced angulated paediatric forearm fractures have the potential to remodel in time and have good radiographic and functional outcome one year after trauma, where pronation and grip strength take the longest to recover