969:. In the 18th century, Petit first suggested that these types of injuries might be due to fractures rather than dislocations. Another author, Pouteau, suggested the common mechanism of injury which leads to this type of fractures - injury to the wrist when a person falls on an outstretched hand with dorsal displacement of the wrist. However, he also suggested that volar displacement of the wrist was due to the ulnar fracture. His work was met with skepticism from colleagues and little recognition, since the article was published after he died. In 1814, Abraham Colles described the characteristics of distal end radius fracture. In 1841, Guilaume Dupuytren acknowledged the contributions by Petit and Pouteau, agreeing that the distal end radius fracture is indeed a fracture, not a dislocation. In 1847, Malgaigne described the mechanism of injury for distal end radius fractures that can be caused by falling on the outstretched hand or on the back of the hand and also the consequences if the hand fracture is not treated adequately. After that, Robert William Smith, professor of surgery in Dublin, Ireland, first described the characteristics of volar displacement of distal radius fractures. In 1895, with the advent of X-rays, the visualisation of the distal radius fracture became more apparent. Lucas-Champonnière first described the management of fractures using massage and early mobilization techniques.
851:
however the peak ages differ slightly. Girls peak at 11 years old and boys peak at 14 years old (the age that children experience the most fractures). For adults, incidences in females outnumber incidences in males by a factor of three to two. In adults, the average age of occurrence is between 57 and 66 years. Men who sustain distal radius fractures are usually younger, generally in their 40s (vs. 60s in females). Low energy injury (usually fall from standing height) is the usual cause of distal end radius fracture (66 to 77% of cases). High energy injuries accounts for 10% of wrist fractures. About 57% to 66% of the fractures are extra-articular fractures, 9% to 16% are partial-articular fractures, and 25% to 35% are complete articular fractures. Unstable metaphyseal fractures are ten times more common than severe articular fractures. Older people with osteoporosis who are still active are at an increased risk of getting distal radius fractures.
697:, only then is a reduction indicated. If the instability risk is less than 70%, the hand can be manipulated under regional block or general anaesthesia to achieve reduction. If the post reduction radiology of the wrist is acceptable, then the person can come for follow up at one, two, or three weeks to look for any displacement of fractures during this period. If the reduction is maintained, then the cast should continue for 4 to 6 weeks. If the fracture is displaced, surgical management is the proper treatment. If the instability risk of the wrist is more than 70%, then surgical management is required. 43% of displaced fractures will be unstable within the first two weeks and 47% of the remaining unstable fractures will become unstable after two weeks. Therefore, periodic reviews are important to prevent malunion of the displaced fractures.
324:
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maximize strength and function in the affected upper extremity. Surgeons use these factors combined with radiologic imaging to predict fracture instability, and functional outcome to help decide which approach would be most appropriate. Treatment is often directed to restore normal anatomy to avoid the possibility of malunion, which may cause decreased strength in the hand and wrist. The decision to pursue a specific type of management varies greatly by geography, physician specialty (hand surgeons vs. orthopedic surgeons), and advancements in new technology such as the volar locking plating system.
817:(WHO) divides outcomes into three categories: impairment, disabilities, and handicaps. Impairment is the abnormal physical function, such as lack of forearm rotation. It is measured clinically. Disability is the lack of ability to perform physical daily activities. It is measured by Patient Reported Outome Measures (PROMs). Examples of scoring system based on clinical assessment are: Mayo Wrist Score (for perilunate fracture dislocation), Green and O’Brien Score (carpal dislocation and pain), and Gartland and Werley Score (evaluating distal radius fractures). These scores includes assessment of
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successfully with nonsurgical management; however, in more active and fit patients with fractures that are reducible by closed means, nonbridging external fixation is preferred, as it has less serious complications when compared to other surgical options. The most common complication associated with nonbridging external fixation is pin tract infection, which can be managed with antibiotics and frequent dressing changes, and rarely results in reoperation. The external fixator is placed for 5 to 6 weeks and can be removed in an outpatient setting.
424:
580:, and complete (or off-ended) fractures. Buckle fractures are an incomplete break in the bone that involves the cortex (outside) of the bone. Buckle fractures are stable and are the most common type. Greenstick fractures are a bone that is broken only on one side and the bone bows to the other side. Greenstick fractures are unstable and often occur in younger children. Complete fractures, where the bone is completely broken, are unstable. In a complete fracture the bone can be misaligned. For a complete fracture, a
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outcome from early mobilization (prior to 6 weeks after surgical fixation) has been shown. Although restoration of radiocarpal alignment is thought to be of obvious importance, the exact amount of angulation, shortening, intra-articular gap/step which impact final function are not exactly known. The alignment of the DRUJ is also important, as this can be a source of a pain and loss of rotation after final healing and maximum recovery.
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degrees. Radial styloid fracture would occur if the wrist is ulnar deviated and vice versa. If the wrist is bent back less, then proximal forearm fracture would occur, but if the bending back is more, then the carpal bones fracture would occur. With increased bending back, more force is required to produce a fracture. More force is required to produce a fracture in males than females. Risk of injury increases in those with
40:
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542:- It is the vertical distance between a horizontal line parallel to the articular surface of the radius and another horizontal line drawn parallel to the articular surface of the ulnar head. Positive ulnar variance (ulna appears longer than radius) disturbs the integrity of triangular fibrocartilage complex and is associated with loss of grip strength and wrist pain.
806:
reduction can generally be avoided. Percutaneous pinning is preferred to plating due to similar clinical and radiological outcomes, as well as lower costs, when compared to plating, despite increased risk of superficial infections. Level of joint restoration, as opposed to surgical technique, has been found to be a better indicator of functional outcomes.
977:, immobilization and external fixation have all contributed to the management of fixation of distal radius fracture. Ombredanne, a Parisian surgeon in 1929, first reported the use of nonbridging external fixation in the management of distal radius fractures. Bridging external fixation was introduced by Roger Anderson and Gordon O’Neill from
509:- A line is drawn joining the most distal ends of the volar and dorsal side of the radius. Another line perpendicular to the longitudinal axis of the radius is drawn. The angle between the two lines is the angle of volar or dorsal tilt of the wrist. Measurement of volar or dorsal tilt should be made in true lateral view of the wrist because
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and range of motion in patients' wrists occurred when comparing conservative nonsurgical approaches with surgical management. Although the nonsurgical group exhibited greater anatomic misalignment such as radial deviation, and ulnar variance, these changes did not seem to have significant impact on overall pain and quality of life.
348:, however, is not uncommon, and can lead to residual pain, grip weakness, reduced range of motion (especially rotation), and persistent deformity. Symptomatic malunion may require additional surgery. If the joint surface is damaged and heals with more than 1–2 mm of unevenness, the wrist joint will be prone to post-traumatic
677:. Therefore, follow up within the first week of fracture is important. 22% of the minimally displaced fractures will malunite after two weeks. Subsequent follow ups at two to three weeks are therefore also important. There is weak evidence to suggest that some children with a buckle fracture may not require cast immobilization.
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If the fractures are unlikely to be reduced by closed means, open reduction with internal plate fixation is preferred. Although major complications (i.e. tendon injury, fracture collapse, or malunion) result in higher reoperation rates (36.5%) compared to external fixation (6%), ORIF is preferred, as
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For those with low demand, cast and splint can be applied for two weeks. In those who are young and active, if the fracture is not displaced, the patient can be followed up in one week. If the fracture is still undisplaced, cast and splint can be applied for three weeks. If the fracture is displaced,
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for six weeks or surgery. Surgery is generally indicated if the joint surface is broken and does not line up, the radius is overly short, or the joint surface of the radius is tilted more than 10% backwards. Among those who are cast, repeated X-rays are recommended within three weeks to verify that a
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Pronated oblique view of the distal radius helps to show the degree of comminution of the distal end radius, depression of the radial styloid, and confirming the position the screws at the radial side of the distal end radius. Meanwhile, a supinated oblique view of shows the ulnar side of the distal
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injuries, especially scapholunate (4.7% to 46% of cases) and lunotriquetral ligaments (12% to 34% of cases) injuries. There is an increased risk of interosseous intercarpal injury if the ulnar variance (the difference in height between the distal end of the ulna and the distal end of the radius) is
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There are also two scoring systems for
Patient Reported Outome Measures (PROMs): the Disabilities of Hand, Arm and Shoulder (DASH) Score and the Patient-Related Wrist Evaluation (PRWE) Score. These scoring systems measures the ability of a person to perform a task, pain score, presence of tingling
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Despite these risks with nonoperative treatment, more recent systematic reviews suggest that when indicated, nonsurgical management in the elderly population may lead to similar functional outcomes as surgical approaches. In these studies, no significant differences in pain scores, grip strength,
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There are many classification systems for distal radius fracture. AO/OTA classification is adopted by
Orthopaedic Trauma Association and is the most commonly used classification system. There are three major groups: A—extra-articular, B—partial articular, and C—complete articular which can further
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fractures. The characteristics of distal radius fractures are influenced by the position of the hand at the time of impact, the type of surface at point of contact, the speed of the impact, and the strength of the bone. Distal radius fractures typically occur with the wrist bent back from 60 to 90
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These fractures are the most common of the three groups mentioned above that require surgical management. A minimal articular fracture involves the joint, but does not require reduction of the joint. Manipulative reduction and immobilization were thought to be appropriate for metaphyseal unstable
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Treatment options for distal radius fractures include nonoperative management, external fixation, and internal fixation. Indications for each depend on a variety of factors such as the patient's age, initial fracture displacement, and metaphyseal and articular alignment, with the ultimate goal to
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Distal radius fractures are the most common fractures seen in adults and children. Distal radius fractures account for 18% of all adult fractures with an approximate rate of 23.6 to 25.8 per 100,000 per year. For children, both boys and girls have a similar incidence of these types of fractures,
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In the elderly, distal radius fractures heal and may result in adequate function following nonoperative treatment. A large proportion of these fractures occur in elderly people who may have less requirement for strenuous use of their wrists. Some of these patients tolerate severe deformities and
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Where the fracture is undisplaced and stable, nonoperative treatment involves immobilization. Initially, a backslab or a sugar tong splint is applied to allow swelling to expand and subsequently a cast is applied. Depending on the nature of the fracture, the cast may be placed above the elbow to
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bone and another line is drawn along the long axis of the radius. If the carpal bones are aligned, both lines will intersect within the carpal bones. If the carpal bones are not aligned, both lines will intersect outside the carpal bones. Carpal malignment is frequently associated with dorsal or
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can be used at the time of fixation to evaluate for soft-tissue injury and the congruity of the joint surface and may increase the accuracy of joint surface alignment
Structures at risk include the triangular fibrocartilage complex and the scapholunate ligament. Scapholunate injuries in radial
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Failure of nonoperative treatment leading to functional impairment and anatomic deformity is the largest risk associated with conservative management. Prior studies have shown that the fracture often redisplaces to its original position even in a cast. Only 27-32% of fractures are in acceptable
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These fractures, although less common, often require surgery in active, healthy patients to address displacement of both the joint and the metaphysis. The two mainstays of treatment are bridging external fixation or ORIF. If reduction can be achieved by closed/percutaneous reduction, then open
764:
Significant advances have been made in ORIF treatments. Two newer treatments are fragment-specific fixation and fixed-angle volar plating. These attempt fixation rigid enough to allow almost immediate mobility, in an effort to minimize stiffness and improve ultimate function; no improved final
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The majority of distal radius fractures are treated with conservative nonoperative management, which involves immobilization through application of plaster or splint with or without closed reduction. The prevalence of nonoperative approach to distal radius fractures is around 70%. Nonoperative
246:
Distal radius fractures are common, and are the most common type of fractures that are seen in children. Distal radius fractures represent between 25% and 50% of all broken bones and occur most commonly in young males and older females. A year or two may be required for healing to occur. Most
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Surgical options have been shown to be successful in patients with unstable extra-articular or minimal articular distal radius fractures. These options include percutaneous pinning, external fixation, and ORIF using plating. Patients with low functional demand of their wrists can be treated
761:, or some combination of the above. The choice of operative treatment is often determined by the type of fracture, which can be categorized broadly into three groups: partial articular fractures, displaced articular fractures, and metaphyseal unstable extra- or minimal articular fractures.
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alignment 5 weeks after closed reduction. For those less than 60 years in age, there will be a dorsal angulation of 13 degrees, while for those older than 60, the dorsal angulation can reach as high as 18 degrees. In people over 60, functional impairment can last for more than 10 years.
291:, usually at the side. Tenderness at an area with no obvious deformity may still point to underlying fractures. Decreased sensation especially at the tips of the radial three and one half digits ( thumb, index finger, middle finger and radial portion of the ring finger ) can be due to
388:
The most common cause of this type of fracture is a fall on an outstretched hand from standing height, although some fractures will be due to high-energy injury. People who fall on the outstretched hand are usually fitter and have better reflexes when compared to those with elbow or
837:
In young patients, the injury requires greater force and results in more displacement, particularly to the articular surface. Unless an accurate reduction of the joint surface is obtained, these patients are very likely to have long-term symptoms of pain, arthritis, and stiffness.
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X-ray of the affected wrist is required if a fracture is suspected. Posteroanterior, lateral, and oblique views can be used together to describe the fracture. X-ray of the uninjured wrist should also be taken to determine if any normal anatomic variations exist before surgery.
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then manipulative reduction or surgical stabilisation is required. Shorter immobilization is associated with better recovery when compared to prolonged immobilization. 10% of the minimally displaced fractures will become unstable in the first two weeks and cause
664:
management is indicated for fractures that are undisplaced, or for displaced fractures that are stable following reduction. Variations in immobilization techniques involve the type of cast, position of immobilization, and the length of time required in the cast.
2018:
Gradl, Georg; Gradl, Gertraud; Wendt, Martina; Mittlmeier, Thomas; Kundt, Guenther; Jupiter, Jesse B. (1 May 2013). "Non-bridging external fixation employing multiplanar K-wires versus volar locked plating for dorsally displaced fractures of the distal radius".
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subdivided into nine main groups and 27 subgroups depending on the degree of communication and direction of displacement. However, none of the classification systems demonstrate good liability. A qualification modifier (Q) is used for associated ulnar fracture.
497:- It is the angle between the line that pass through the central axis of the volar rim of the lunate facet of the radius and the line that pass through the long axis of the radius. Tear drop angle less than 45 degrees indicates displacement of lunate facet.
842:
minor loss of wrist motion very well, even without reduction of the fracture. There is no difference in functional outcomes between operative and non-operative management in the elderly age group, despite better anatomical results in the operative group.
526:- It is the angle between a line drawn from the radial styloid to the medial end of the articular surface of the radius and a line drawn perpendicular to the long axis of the radius. Loss of radial inclination is associated with loss of grip strength.
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Ju, Ji-Hui; Jin, Guang-Zhe; Li, Guan-Xing; Hu, Hai-Yang; Hou, Rui-Xing (1 October 2015). "Comparison of treatment outcomes between nonsurgical and surgical treatment of distal radius fracture in elderly: a systematic review and meta-analysis".
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Nerve injury, especially of the median nerve and presenting as carpal tunnel syndrome, is commonly reported following distal radius fractures. Tendon injury can occur in people treated both nonoperatively and operatively, most commonly to the
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fracture increases the risk of TFCC injury by a factor of 5:1. However, it is unclear whether intercarpal ligaments and triangular fibrocartilage injuries are associated with long term pain and disability for those who are affected.
685:, a splint may be sufficient and casting may be avoided. The position of the wrist in cast is usually slight flexion and ulnar deviation. However, neutral and dorsiflex position may not affect the stability of the fracture.
503:(AP distance) - Seen on lateral X-ray, it is the distance between the dorsal and volar rim of the lunate facet of the radius. The usual distance is 19 mm. Increased AP distance indicates the lunate facet fracture.
371:
Complex regional pain syndrome is also associated with distal radius fractures, and can present with pain, swelling, changes in color and temperature, and/or joint contracture. The cause for this condition is unknown.
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designed orthopaedic clamps, which allow adjustments of the external fixator to reduce the fractures by closed reduction. In 1907, percutaneous pinning was first used. This was followed by the use of plating in 1965.
780:(bony alignment) is not properly restored, function may remain poor even after healing. Restoration of bony alignment is not a guarantee of success, as soft tissue contributes significantly to the healing process.
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Swelling, deformity, tenderness, and loss of wrist motion are normal features on examination of a person with a distal radius fracture. "Dinner fork" deformity of the wrist is caused by dorsal displacement of the
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Edwards, Charles C.; Haraszti, Christopher J.; McGillivary, Gary R.; Gutow, Andrew P. (1 November 2001). "Intra-articular distal radius fractures: Arthroscopic assessment of radiographically assisted reduction".
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720:. Manipulation generally includes first placing the arm under traction and unlocking the fragments. The deformity is then reduced with appropriate closed manipulative (depending on the type of deformity)
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In children, the outcome of distal radius fracture is usually very good with healing and return to normal function expected. Some residual deformity is common, but this often remodels as the child grows.
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X-rays of pins across a distal radius fracture: Notice the ulnar styloid base fracture, which has not been fixed. This patient has instability of the DRUJ because the TFCC is not in continuity with the
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this provides better stability and restoration of the volar tilt. Following the operation, a removable splint is placed for 2 weeks, during which time patients should mobilize the wrist as tolerated.
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styloid fractures where the fracture line exits distally at the scapholunate interval should be considered. TFCC injuries causing obvious DRUJ instability can be addressed at the time of fixation.
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Earnshaw, SA; Aladin, A; Surendran, S; Moran, CG (March 2002). "Closed reduction of colles fractures: Comparison of manual manipulation and finger-trap traction: a prospective, randomized study".
352:. Half of nonosteoporotic patients will develop post-traumatic arthritis, specifically limited radial deviation and wrist flexion. This arthritis can worsen over time. Displaced fractures of the
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fractures. However, several studies suggest this approach is largely ineffective in patients with high functional demand, and in this case, more stable fixation techniques should be used.
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of the forearm reduces the volar tilt and supination increases it. When dorsal tilt is more than 11 degrees, it is associated with loss of grip strength and loss of wrist flexion.
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and wrist dislocations, which can also co-exist with a distal radius fracture. Occasionally, fractures may not be seen on X-rays immediately after the injury. Delayed X-rays,
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People usually present with a history of falling on an outstretched hand and complaint of pain and swelling around the wrist, sometimes with deformity around the wrist. Any
532:- It is the vertical distance in millimetres between a line tangential to the articular surface of the ulna and a tangential line drawn at the most distal point of radius (
471:
A CT scan is often performed to further investigate the articular anatomy of the fracture, especially for fracture and displacement within the distal radio-ulnar joint.
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recommends that postreduction lateral wrist X-rays should be obtained in all patients with distal radius fractures in order to preclude DRUJ injuries or dislocations.
1384:"Prevalence of posttraumatic arthritis and the association with outcome measures following distal radius fractures in non-osteoporotic patients: a systematic review"
821:, grip strength, ability to perform activities of daily living, and radiological picture. However, none of the three scoring system demonstrated good reliability.
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children with a buckle wrist fracture experience a broken wrist for life and do have an increased chance of re-fracturing the same spot or other adverse effects.
1339:. Court-Brown, Charles M.,, Heckman, James D.,, McQueen, Margaret M.,, Ricci, William M.,, Tornetta, Paul, III,, McKee, Michael D. (8th ed.). Philadelphia.
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Court-Brown, Charles M.; Aitken, Stuart; Hamilton, Thomas W.; Rennie, Louise; Caesar, Ben (2010). "Nonoperative
Fracture Treatment in the Modern Era".
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In displaced distal radius fracture, in those with low demands, the hand can be cast until the person feels comfortable. If the fracture affects the
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radius, accessing the depression of dorsal rim of the lunate facet, and the position of the screws on the ulnar side of the distal end radius.
2065:"Outcomes After Distal Radius Fracture Treatment With Percutaneous Wire Versus Plate Fixation: Meta-Analysis of Randomized Controlled Trials"
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X-ray of a displaced intra-articular distal radius fracture in an external fixator: The articular surface is widely displaced and irregular.
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Court-Brown, Charles M.; Heckman, James D.; McQueen, Margaret M.; Ricci, William M.; (Iii), Paul
Tornetta; McKee, Michael D. (2015).
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MacIntyre, Norma J.; Dewan, Neha (April 2016). "Epidemiology of distal radius fractures and factors predicting risk and prognosis".
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tendon. This can be due to the tendon coming in contact with protruding bone or with hardware placed following surgical procedures.
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and numbness, the effect on activities of daily living, and self-image. Both scoring systems show good reliability and validity.
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and requires prompt treatment. Very rarely, pressure on the muscle components of the hand or forearm is sufficient to create a
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injuries. Any pain in the limb of the same side should also be investigated to exclude associated injuries to the same limb.
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McQueen, M. M.; Hajducka, C.; Court-Brown, C. M. (1 May 1996). "Redisplaced unstable fractures of the distal radius".
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Handoll, Helen HG; Elliott, Joanne; Iheozor-Ejiofor, Zipporah; Hunter, James; Karantana, Alexia (19 December 2018).
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Alluri, RK; Hill, JR; Ghiassi, A (August 2016). "Distal Radius
Fractures: Approaches, Indications, and Techniques".
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Surgery is generally indicated for displaced or unstable fractures. The techniques of surgical management include
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Lameijer, C. M.; ten Duis, H. J.; van
Dusseldorp, I.; Dijkstra, P. U.; van der Sluis, C. K. (1 November 2017).
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is taken to ensure that the reduction was successful. The cast is usually maintained for about 6 weeks.
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McQueen, MM; MacLaren, A; Chalmers, J (1 March 1986). "The value of remanipulating Colles' fractures".
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control forearm rotation. However, an above-elbow cast may cause long-term rotational contracture. For
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Posttraumatic arthritis of the wrist, degeneration of the articular surface before and after resection
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base associated with a distal radius fracture result in instability of the DRUJ and resulting loss of
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Distal radius fractures are often associated with distal radial ulnar joint (DRUJ) injuries, and the
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215:. In older people, the most common cause is falling on an outstretched hand. Specific types include
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1689:"BestBets: Is a cast as useful as a splint in the treatment of a distal radius fracture in a child"
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Diagnosis may be evident clinically when the distal radius is deformed, but should be confirmed by
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injury. Swelling and displacement can cause compression on the median nerve which results in acute
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Abbaszadegan, H; von Sivers, K; Jonsson, U (1988). "Late displacement of Colles' fractures".
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Before the 18th century, distal radius fracture was believed to be due to dislocation of the
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Correction should be undertaken if the wrist radiology falls outside the acceptable limits:
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which is close to the wrist. Symptoms include pain, bruising, and rapid-onset swelling. The
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Medoff, RJ (August 2005). "Essential radiographic evaluation for distal radius fractures".
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1533:"Trends in the United States in the Treatment of Distal Radial Fractures in the Elderly"
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Anderson, Mark S.; Ghamsary, Mark; Guillen, Phillip T.; Wongworawat, Montri D. (2017).
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volar tilt of the radius and will have poor grip strength and poor forearm rotation.
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1610:. Sarwark, John F. Rosemont, Ill.: American Academy of Orthopaedic Surgeons. 2010.
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Fracture with a dorsal tilt: Dorsal is left, and volar is right in the image.
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231:. The diagnosis is generally suspected based on symptoms and confirmed with
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For children and adolescents, there are three main categories of fracture:
536:). Shortening of radial length more than 4mm is associated with wrist pain.
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Malreduced distal radius fracture demonstrating the deformity in the wrist
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If carpus is aligned, then the dorsal tilt should be less than 10 degrees
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are those in which the skin and tissue lying over the bone is intact. An
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Various kinds of information can be obtained from X-rays of the wrist:
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287:. Examination should also rule out a skin wound which might suggest an
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1435:(8th ed.). Philadelphia, Pa.: Lippincott Williams & Wilkins.
1381:
384:
Arthroscopic image of a central triangular fibrocartilage complex tear
211:
In younger people, these fractures typically occur during sports or a
1499:
Hsu, Hunter; Fahrenkopf, Matthew P.; Nallamothu, Shivajee V. (2020),
510:
205:
169:
864:
303:
which can manifest as severe pain and sensory deficits in the hand.
1176:
713:
674:
487:
345:
341:
2061:
978:
777:
655:
Most children with these types of fractures do not need surgery.
390:
357:
39:
2095:
Nellans, Kate W.; Kowalski, Evan; Chung, Kevin C. (1 May 2012).
2188:
1870:
1652:
986:
604:
283:). The wrist may be radially deviated due to shortening of the
1531:
Chung, Kevin C; Shauver, Melissa J; Birkmeyer, John D (2009).
1334:
981:
in 1944 due to poor results in conservative management (using
1979:"Epidemiology of distal radius fracture in Stockholm 1981–82"
1701:
725:
432:
1744:
700:
Closed reduction of a distal radius fracture involves first
401:
Common injuries associated with distal radius fractures are
380:
1655:
The
Journal of Trauma: Injury, Infection, and Critical Care
1906:
776:
Prognosis varies depending on dozens of variables. If the
406:
more than 2mm and there is fracture into the wrist joint.
2437:
2017:
1035:"Distal Radius Fractures (Broken Wrist)-OrthoInfo - AAOS"
634:
If carpus is aligned, there are no limits for palmar tilt
51:
as seen on X-ray: It is a type of distal radius fracture.
1179:"Interventions for treating wrist fractures in children"
1941:
1498:
2148:
1537:
The
Journal of Bone and Joint Surgery. American Volume
800:
1944:
The Journal of Bone and Joint Surgery. British Volume
1909:
The Journal of Bone and Joint Surgery. British Volume
1530:
1172:
1170:
637:
If carpus is malaligned, wrist tilt should be neutral
410:
complex (TFCC) injury occurs in 39% to 82% of cases.
2166:
2094:
1834:"Distal Radius Open Reduction and Internal Fixation"
1168:
1166:
1164:
1162:
1160:
1158:
1156:
1154:
1152:
1150:
731:
1330:
1328:
1326:
1324:
1322:
1320:
1318:
1316:
1314:
1312:
1310:
1308:
1306:
1304:
1302:
1300:
1298:
1296:
1294:
1292:
1290:
1288:
1286:
1284:
1282:
1280:
1278:
1276:
1274:
1272:
1270:
1268:
1266:
1264:
1262:
1260:
1258:
1256:
1254:
1252:
1250:
1248:
1246:
1244:
1242:
985:) of distal end radius fractures. Raoul Hoffman of
2270:
2063:
1240:
1238:
1236:
1234:
1232:
1230:
1228:
1226:
1224:
1222:
279:). Reverse deformity is seen in volar angulation (
1147:
1118:
2867:
724:, after which a splint or cast is placed and an
1507:, Treasure Island (FL): StatPearls Publishing,
1219:
1076:
2256:
2097:"The Epidemiology of Distal Radius Fractures"
486:- A line is drawn along the long axis of the
344:is rare; almost all of these fractures heal.
1831:
1183:The Cochrane Database of Systematic Reviews
783:
2263:
2249:
2021:Archives of Orthopaedic and Trauma Surgery
1976:
1388:Archives of Orthopaedic and Trauma Surgery
1367:: CS1 maint: location missing publisher (
38:
16:Fracture of the radius bone near the wrist
2120:
1994:
1787:
1556:
1407:
1202:
1072:
1070:
1068:
1066:
1064:
1062:
1060:
1029:
1027:
1025:
1023:
949:Learn how and when to remove this message
564:Classification of distal radius fractures
77:Pain, bruising, and swelling of the wrist
2070:Journal of Surgical Orthopaedic Advances
1433:Rockwood and Green's Fractures in Adults
1337:Rockwood and Green's fractures in adults
1114:
1112:
1110:
1108:
1021:
1019:
1017:
1015:
1013:
1011:
1009:
1007:
1005:
1003:
667:
650:American Academy of Orthopaedic Surgeons
611:
603:
595:
458:
422:
379:
2868:
1455:
1057:
688:
640:Gap or step deformity is less than 2mm
628:There should be no carpus malalignment
2244:
1977:Schmalholz, Anders (1 January 1988).
1832:Ilyas, Asif; Richey, Bradley (2020).
1602:
1600:
1430:
1105:
1000:
250:
2358:Zygomaticomaxillary complex fracture
887:adding citations to reliable sources
858:
588:(exposed bone) is a serious injury.
801:Displaced intra-articular fractures
13:
2751:Combined tibia and fibula fracture
2154:Wheeless' Textbook of Orthopaedics
1608:Essentials of musculoskeletal care
1597:
454:
403:interosseous intercarpal ligaments
14:
2887:
2141:
1424:
732:Outcome of nonoperative treatment
557:
451:(MRI) can confirm the diagnosis.
1791:Langenbeck's Archives of Surgery
1759:10.2106/00004623-200203000-00004
1045:from the original on 2 July 2017
863:
751:open reduction internal fixation
336:
322:
310:
2088:
2055:
2011:
1970:
1935:
1900:
1864:
1825:
1781:
1738:
1695:
1681:
1646:
1573:
1524:
1431:Ricci, William M., ed. (2015).
874:needs additional citations for
845:
710:intravenous regional anesthesia
658:
2426:Vertebral compression fracture
1983:Acta Orthopaedica Scandinavica
1956:10.1302/0301-620X.68B2.3958009
1921:10.1302/0301-620X.78B3.0780404
1492:
1449:
1375:
1195:10.1002/14651858.CD012470.pub2
967:distal radioulnar articulation
1:
993:
828:
625:2-3mm positive ulnar variance
243:good position is maintained.
591:
418:
7:
1667:10.1097/ta.0b013e3181b57ace
1121:The Journal of Hand Surgery
965:or the displacement of the
259:should be asked to exclude
10:
2892:
2401:Craniocervical instability
1838:Journal of Medical Insight
1133:10.1016/j.jhsa.2016.05.015
854:
809:
744:
561:
449:Magnetic resonance imaging
174:Recovery over 1 to 2 years
2820:
2797:
2778:
2749:
2736:Le Fort fracture of ankle
2720:
2669:
2662:
2639:
2596:
2520:
2491:
2482:
2459:
2436:
2406:Flexion teardrop fracture
2371:
2353:Le Fort fracture of skull
2323:
2282:
2214:
2170:
2113:10.1016/j.hcl.2012.02.001
2033:10.1007/s00402-013-1698-5
1996:10.3109/17453678809149429
1803:10.1007/s00423-015-1324-9
1470:10.1016/j.hcl.2005.02.008
1400:10.1007/s00402-017-2765-0
1091:10.1016/j.jht.2016.03.003
815:World Health Organization
704:the affected area with a
501:Antero-posterior distance
445:X-ray computed tomography
408:Triangular fibrocartilage
178:
168:
155:
144:
131:
119:
111:
89:
81:
71:
55:
46:
37:
29:
24:
898:"Distal radius fracture"
784:Little joint involvement
608:X-rays of a wrist fusion
574:buckle (torus) fractures
375:
366:extensor pollicis longus
2582:Essex-Lopresti fracture
2512:Holstein–Lewis fracture
2163:Fractures of the Radius
1886:10.1053/jhsu.2001.28760
1874:Journal of Hand Surgery
1585:www.orthoguidelines.org
1079:Journal of Hand Therapy
329:"Dinner fork" deformity
213:motor vehicle collision
2396:Clay-shoveler fracture
2333:Basilar skull fracture
1638:: CS1 maint: others (
618:
609:
601:
464:
437:differential diagnosis
428:
385:
297:carpal tunnel syndrome
190:distal radius fracture
25:Distal radius fracture
2760:Trimalleolar fracture
2229:- 21-C3 21-A1 - 21-C3
668:Undisplaced fractures
615:
607:
599:
462:
426:
412:Ulnar styloid process
383:
229:Chauffeur's fractures
2765:Bimalleolar fracture
2731:Maisonneuve fracture
1747:J Bone Joint Surg Am
1549:10.2106/jbjs.h.01297
883:improve this article
759:percutaneous pinning
578:greenstick fractures
518:Posteroanterior view
507:Volar or dorsal tilt
301:compartment syndrome
208:may also be broken.
182:≈33% of broken bones
2416:Holdsworth fracture
2343:Mandibular fracture
2310:Pathologic fracture
2300:Greenstick fracture
2295:Chalkstick fracture
689:Displaced fractures
484:Carpal malalignment
200:of the part of the
137:Based on symptoms,
106:Hutchinson fracture
2695:Toddler's fracture
2536:Monteggia fracture
2421:Jefferson fracture
2411:Hangman's fracture
2215:External resources
2159:2019-01-27 at the
1716:10.1007/BF00547163
1039:orthoinfo.aaos.org
718:general anesthesia
619:
610:
602:
524:Radial inclination
465:
441:scaphoid fractures
429:
386:
251:Signs and symptoms
238:Treatment is with
66:emergency medicine
2863:
2862:
2816:
2815:
2741:Bosworth fracture
2690:Gosselin fracture
2649:Duverney fracture
2592:
2591:
2461:Shoulder fracture
2381:Cervical fracture
2290:Avulsion fracture
2238:
2237:
1850:10.24296/jomi/301
1581:"OrthoGuidelines"
1394:(11): 1499–1513.
1346:978-1-4511-7531-8
975:aseptic technique
959:
958:
951:
933:
755:external fixation
186:
185:
133:Diagnostic method
102:Barton's fracture
19:Medical condition
2883:
2799:Femoral fracture
2789:Patella fracture
2722:Fibular fracture
2712:Tillaux fracture
2705:Plafond fracture
2667:
2666:
2522:Forearm fracture
2493:Humerus fracture
2489:
2488:
2451:Sternal fracture
2338:Blowout fracture
2276:cartilage damage
2265:
2258:
2251:
2242:
2241:
2168:
2167:
2135:
2134:
2124:
2092:
2086:
2085:
2067:
2059:
2053:
2052:
2015:
2009:
2008:
1998:
1974:
1968:
1967:
1939:
1933:
1932:
1904:
1898:
1897:
1880:(6): 1036–1041.
1868:
1862:
1861:
1829:
1823:
1822:
1785:
1779:
1778:
1742:
1736:
1735:
1699:
1693:
1692:
1685:
1679:
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1650:
1644:
1643:
1637:
1629:
1604:
1595:
1594:
1592:
1591:
1577:
1571:
1570:
1560:
1543:(8): 1868–1873.
1528:
1522:
1521:
1520:
1519:
1501:"Wrist Fracture"
1496:
1490:
1489:
1453:
1447:
1446:
1428:
1422:
1421:
1411:
1379:
1373:
1372:
1366:
1358:
1332:
1217:
1216:
1206:
1189:(12): CD012470.
1174:
1145:
1144:
1116:
1103:
1102:
1074:
1055:
1054:
1052:
1050:
1031:
983:orthopaedic cast
954:
947:
943:
940:
934:
932:
891:
867:
859:
712:(Bier's block),
582:closed fractures
326:
314:
281:Smith's fracture
277:Colle's fracture
192:, also known as
98:Smith's fracture
94:Colles' fracture
42:
22:
21:
2891:
2890:
2886:
2885:
2884:
2882:
2881:
2880:
2866:
2865:
2864:
2859:
2812:
2793:
2774:
2770:Pott's fracture
2745:
2716:
2685:Segond fracture
2680:Bumper fracture
2658:
2654:Pipkin fracture
2641:Pelvic fracture
2635:
2588:
2548:Radius fracture
2516:
2478:
2455:
2432:
2391:Chance fracture
2373:Spinal fracture
2367:
2363:Zygoma fracture
2319:
2315:Spiral fracture
2278:
2269:
2239:
2234:
2233:
2210:
2209:
2179:
2161:Wayback Machine
2150:Radius and Ulna
2144:
2139:
2138:
2093:
2089:
2060:
2056:
2016:
2012:
1975:
1971:
1940:
1936:
1905:
1901:
1869:
1865:
1830:
1826:
1786:
1782:
1743:
1739:
1700:
1696:
1687:
1686:
1682:
1651:
1647:
1631:
1630:
1618:
1606:
1605:
1598:
1589:
1587:
1579:
1578:
1574:
1529:
1525:
1517:
1515:
1497:
1493:
1454:
1450:
1443:
1429:
1425:
1380:
1376:
1360:
1359:
1347:
1333:
1220:
1175:
1148:
1117:
1106:
1075:
1058:
1048:
1046:
1033:
1032:
1001:
996:
955:
944:
938:
935:
892:
890:
880:
868:
857:
848:
831:
819:range of motion
812:
803:
786:
747:
734:
691:
683:torus fractures
670:
661:
594:
566:
560:
495:Tear drop angle
457:
455:Medical imaging
421:
378:
339:
334:
333:
332:
331:
330:
327:
319:
318:
315:
253:
162:Pain medication
49:Colles fracture
20:
17:
12:
11:
5:
2889:
2879:
2878:
2876:Bone fractures
2861:
2860:
2858:
2857:
2852:
2847:
2842:
2837:
2832:
2826:
2824:
2818:
2817:
2814:
2813:
2811:
2810:
2804:
2802:
2795:
2794:
2792:
2791:
2785:
2783:
2776:
2775:
2773:
2772:
2767:
2762:
2756:
2754:
2747:
2746:
2744:
2743:
2738:
2733:
2727:
2725:
2718:
2717:
2715:
2714:
2709:
2708:
2707:
2700:Pilon fracture
2697:
2692:
2687:
2682:
2676:
2674:
2671:Tibia fracture
2664:
2660:
2659:
2657:
2656:
2651:
2645:
2643:
2637:
2636:
2634:
2633:
2628:
2623:
2618:
2613:
2608:
2602:
2600:
2594:
2593:
2590:
2589:
2587:
2586:
2585:
2584:
2579:
2574:
2569:
2564:
2559:
2545:
2544:
2543:
2538:
2527:
2525:
2518:
2517:
2515:
2514:
2509:
2504:
2498:
2496:
2486:
2480:
2479:
2477:
2476:
2471:
2465:
2463:
2457:
2456:
2454:
2453:
2448:
2442:
2440:
2434:
2433:
2431:
2430:
2429:
2428:
2423:
2418:
2413:
2408:
2403:
2398:
2393:
2388:
2386:Burst fracture
2377:
2375:
2369:
2368:
2366:
2365:
2360:
2355:
2350:
2348:Nasal fracture
2345:
2340:
2335:
2329:
2327:
2321:
2320:
2318:
2317:
2312:
2307:
2302:
2297:
2292:
2286:
2284:
2280:
2279:
2268:
2267:
2260:
2253:
2245:
2236:
2235:
2232:
2231:
2219:
2218:
2216:
2212:
2211:
2208:
2207:
2196:
2180:
2175:
2174:
2172:
2171:Classification
2165:
2164:
2151:
2143:
2142:External links
2140:
2137:
2136:
2107:(2): 113–125.
2087:
2054:
2027:(5): 595–602.
2010:
1989:(6): 701–703.
1969:
1950:(2): 232–233.
1934:
1915:(3): 404–409.
1899:
1863:
1824:
1797:(7): 767–779.
1780:
1737:
1694:
1680:
1661:(3): 699–707.
1645:
1616:
1596:
1572:
1523:
1491:
1464:(3): 279–288.
1448:
1442:978-1451175318
1441:
1423:
1374:
1345:
1218:
1146:
1104:
1085:(2): 136–145.
1056:
1041:. March 2013.
998:
997:
995:
992:
957:
956:
871:
869:
862:
856:
853:
847:
844:
830:
827:
811:
808:
802:
799:
785:
782:
746:
743:
733:
730:
706:hematoma block
690:
687:
669:
666:
660:
657:
642:
641:
638:
635:
632:
629:
626:
593:
590:
562:Main article:
559:
558:Classification
556:
555:
554:
544:
543:
540:Ulnar variance
537:
534:radial styloid
527:
515:
514:
504:
498:
492:
456:
453:
447:(CT scan), or
420:
417:
377:
374:
350:osteoarthritis
338:
335:
328:
321:
320:
316:
309:
308:
307:
306:
305:
252:
249:
194:wrist fracture
184:
183:
180:
176:
175:
172:
166:
165:
159:
153:
152:
146:
142:
141:
135:
129:
128:
123:
117:
116:
113:
109:
108:
91:
87:
86:
83:
79:
78:
75:
69:
68:
59:
53:
52:
44:
43:
35:
34:
31:
27:
26:
18:
15:
9:
6:
4:
3:
2:
2888:
2877:
2874:
2873:
2871:
2856:
2853:
2851:
2848:
2846:
2843:
2841:
2838:
2836:
2833:
2831:
2828:
2827:
2825:
2823:
2822:Foot fracture
2819:
2809:
2806:
2805:
2803:
2800:
2796:
2790:
2787:
2786:
2784:
2781:
2780:Crus fracture
2777:
2771:
2768:
2766:
2763:
2761:
2758:
2757:
2755:
2752:
2748:
2742:
2739:
2737:
2734:
2732:
2729:
2728:
2726:
2723:
2719:
2713:
2710:
2706:
2703:
2702:
2701:
2698:
2696:
2693:
2691:
2688:
2686:
2683:
2681:
2678:
2677:
2675:
2672:
2668:
2665:
2661:
2655:
2652:
2650:
2647:
2646:
2644:
2642:
2638:
2632:
2631:Broken finger
2629:
2627:
2624:
2622:
2619:
2617:
2614:
2612:
2609:
2607:
2604:
2603:
2601:
2599:
2598:Hand fracture
2595:
2583:
2580:
2578:
2575:
2573:
2570:
2568:
2565:
2563:
2560:
2558:
2555:
2554:
2553:
2552:Distal radius
2549:
2546:
2542:
2541:Hume fracture
2539:
2537:
2534:
2533:
2532:
2531:Ulna fracture
2529:
2528:
2526:
2523:
2519:
2513:
2510:
2508:
2507:Supracondylar
2505:
2503:
2500:
2499:
2497:
2494:
2490:
2487:
2485:
2481:
2475:
2472:
2470:
2467:
2466:
2464:
2462:
2458:
2452:
2449:
2447:
2444:
2443:
2441:
2439:
2435:
2427:
2424:
2422:
2419:
2417:
2414:
2412:
2409:
2407:
2404:
2402:
2399:
2397:
2394:
2392:
2389:
2387:
2384:
2383:
2382:
2379:
2378:
2376:
2374:
2370:
2364:
2361:
2359:
2356:
2354:
2351:
2349:
2346:
2344:
2341:
2339:
2336:
2334:
2331:
2330:
2328:
2326:
2322:
2316:
2313:
2311:
2308:
2306:
2305:Open fracture
2303:
2301:
2298:
2296:
2293:
2291:
2288:
2287:
2285:
2281:
2277:
2273:
2266:
2261:
2259:
2254:
2252:
2247:
2246:
2243:
2230:
2226:
2225:
2224:AO Foundation
2221:
2220:
2217:
2213:
2206:
2202:
2201:
2197:
2195:
2191:
2190:
2186:
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2146:
2145:
2132:
2128:
2123:
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2110:
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2098:
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2058:
2050:
2046:
2042:
2038:
2034:
2030:
2026:
2022:
2014:
2006:
2002:
1997:
1992:
1988:
1984:
1980:
1973:
1965:
1961:
1957:
1953:
1949:
1945:
1938:
1930:
1926:
1922:
1918:
1914:
1910:
1903:
1895:
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1883:
1879:
1875:
1867:
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1617:9780892035793
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1163:
1161:
1159:
1157:
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1138:
1134:
1130:
1127:(8): 845–54.
1126:
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1115:
1113:
1111:
1109:
1100:
1096:
1092:
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1084:
1080:
1073:
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903:
900: –
899:
895:
894:Find sources:
888:
884:
878:
877:
872:This section
870:
866:
861:
860:
852:
843:
839:
835:
826:
822:
820:
816:
807:
798:
794:
790:
781:
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774:
771:
766:
762:
760:
756:
752:
742:
738:
729:
727:
723:
719:
715:
711:
707:
703:
702:anesthetizing
698:
696:
686:
684:
678:
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665:
656:
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651:
646:
639:
636:
633:
630:
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624:
623:
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614:
606:
598:
589:
587:
586:open fracture
583:
579:
575:
570:
565:
551:
550:
549:
548:
541:
538:
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531:
530:Radial length
528:
525:
522:
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520:
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512:
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489:
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416:
413:
409:
404:
399:
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382:
373:
369:
367:
361:
359:
355:
354:ulnar styloid
351:
347:
343:
337:Complications
325:
313:
304:
302:
298:
294:
290:
289:open fracture
286:
282:
278:
274:
268:
266:
262:
258:
248:
244:
241:
236:
234:
230:
226:
222:
218:
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177:
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150:
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118:
114:
110:
107:
103:
99:
95:
92:
88:
84:
80:
76:
74:
70:
67:
63:
60:
58:
54:
50:
45:
41:
36:
32:
28:
23:
2808:Hip fracture
2551:
2484:Arm fracture
2446:Rib fracture
2222:
2198:
2183:
2104:
2101:Hand Clinics
2100:
2090:
2073:
2069:
2057:
2024:
2020:
2013:
1986:
1982:
1972:
1947:
1943:
1937:
1912:
1908:
1902:
1877:
1873:
1866:
1841:
1837:
1827:
1794:
1790:
1783:
1753:(3): 354–8.
1750:
1746:
1740:
1710:(3): 197–9.
1707:
1703:
1697:
1683:
1658:
1654:
1648:
1607:
1588:. Retrieved
1584:
1575:
1540:
1536:
1526:
1516:, retrieved
1504:
1494:
1461:
1458:Hand Clinics
1457:
1451:
1432:
1426:
1391:
1387:
1377:
1336:
1186:
1182:
1124:
1120:
1082:
1078:
1047:. Retrieved
1038:
963:carpal bones
960:
945:
936:
926:
919:
912:
905:
893:
881:Please help
876:verification
873:
849:
846:Epidemiology
840:
836:
832:
823:
813:
804:
795:
791:
787:
775:
767:
763:
748:
739:
735:
699:
695:median nerve
692:
679:
671:
662:
659:Nonoperative
654:
647:
643:
620:
571:
567:
547:Oblique view
546:
545:
539:
529:
523:
517:
516:
506:
500:
494:
483:
478:Lateral view
477:
476:
473:
470:
466:
430:
400:
396:osteoporosis
387:
370:
362:
340:
293:median nerve
273:carpal bones
269:
254:
245:
237:
210:
193:
189:
187:
126:Osteoporosis
121:Risk factors
33:Broken wrist
2567:Chauffeur's
2076:(1): 7–17.
971:Anaesthesia
770:arthroscope
285:radius bone
265:ulnar nerve
202:radius bone
164:, elevation
82:Usual onset
62:Orthopedics
30:Other names
2855:Broken toe
2205:D000092503
1704:Int Orthop
1590:2017-11-02
1518:2020-11-27
1505:StatPearls
1049:18 October
994:References
909:newspapers
829:Age factor
360:rotation.
157:Medication
2850:Calcaneal
2840:Cuneiform
2616:Bennett's
2272:Fractures
1858:251525983
1634:cite book
1626:706805938
1363:cite book
1355:893628028
939:June 2018
722:reduction
592:Treatment
511:pronation
439:includes
419:Diagnosis
206:ulna bone
179:Frequency
170:Prognosis
151:, surgery
145:Treatment
57:Specialty
2870:Category
2830:Lisfranc
2606:Scaphoid
2577:Barton's
2557:Galeazzi
2502:Proximal
2474:Scapular
2469:Clavicle
2157:Archived
2131:22554654
2082:28459418
2049:10456360
2041:23420065
1894:11721247
1819:32745520
1811:26318178
1775:23661205
1767:11886903
1732:22597586
1675:20065878
1567:19651943
1513:29763147
1486:23616301
1478:16039439
1418:28770349
1213:30566764
1141:27342171
1099:27264899
1043:Archived
753:(ORIF),
714:sedation
675:malunion
488:capitate
346:Malunion
342:Nonunion
257:numbness
73:Symptoms
2626:Busch's
2621:Boxer's
2611:Rolando
2572:Smith's
2562:Colles'
2283:General
2122:3345129
2005:3213460
1964:3958009
1929:8636175
1724:3182123
1558:2714808
1409:5644687
1204:6516962
979:Seattle
923:scholar
855:History
810:Outcome
778:anatomy
745:Surgery
391:humerus
358:forearm
240:casting
196:, is a
149:Casting
2129:
2119:
2080:
2047:
2039:
2003:
1962:
1927:
1892:
1856:
1817:
1809:
1773:
1765:
1730:
1722:
1673:
1624:
1614:
1565:
1555:
1511:
1484:
1476:
1439:
1416:
1406:
1353:
1343:
1211:
1201:
1139:
1097:
987:Geneva
925:
918:
911:
904:
896:
435:. The
261:median
233:X-rays
227:, and
225:Barton
217:Colles
139:X-rays
115:Trauma
112:Causes
85:Sudden
2845:March
2835:Jones
2194:S52.5
2045:S2CID
1854:S2CID
1844:(1).
1815:S2CID
1771:S2CID
1728:S2CID
1482:S2CID
930:JSTOR
916:books
726:X-ray
716:or a
617:ulna.
433:X-ray
376:Cause
221:Smith
198:break
90:Types
2438:Ribs
2325:Head
2274:and
2200:MeSH
2127:PMID
2078:PMID
2037:PMID
2001:PMID
1960:PMID
1948:68-B
1925:PMID
1913:78-B
1890:PMID
1842:2022
1807:PMID
1763:PMID
1751:84-A
1720:PMID
1671:PMID
1640:link
1622:OCLC
1612:ISBN
1563:PMID
1509:PMID
1474:PMID
1437:ISBN
1414:PMID
1369:link
1351:OCLC
1341:ISBN
1209:PMID
1187:2018
1137:PMID
1095:PMID
1051:2017
902:news
263:and
2663:Leg
2185:ICD
2117:PMC
2109:doi
2029:doi
2025:133
1991:doi
1952:doi
1917:doi
1882:doi
1846:doi
1799:doi
1795:400
1755:doi
1712:doi
1663:doi
1553:PMC
1545:doi
1466:doi
1404:PMC
1396:doi
1392:137
1199:PMC
1191:doi
1129:doi
1087:doi
885:by
768:An
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2227::
2203::
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2189:10
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2099:.
2074:26
2072:.
2068:.
2043:.
2035:.
2023:.
1999:.
1987:59
1985:.
1981:.
1958:.
1946:.
1923:.
1911:.
1888:.
1878:26
1876:.
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1840:.
1836:.
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275:(
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