What's New
Check this page frequently to find out what has been added to the site since you last visited and other happenings around the globe related to distal radius fractures.
January 25: we are working on the navigation bar and page design
January 13: we are working on the links
January 12: PicoSearch is now up, forum is up (but barely!)
Happy Birthday!
eRadius is celebrating its Seventh Year of Operation! It was conceptually started in 1998 and launched in January of 1999.
January 9: the PicoSearch utility should be up tonight, many pages were uploaded over the Jan 7-8 weekend.
January 8, 2006
eRadius is now undergoing its most complete revision since it was started in 1999. The original site was database-driven, which was advanced programming at that time, but it is not state of the art in 2006. The site is being re-written in all HTML, is CSS based, and has two new features that did not exist in 1999: a CyberMessage Board (based on the popular phpBB software) so that anyone can post their own cases and all site visitors can add their comments, and a search function by the powerful site search engine PicoSearch. We have also moved to a new host. The planning for the revisions were long in the making, serious changes were instituted in late 2005, and the switch to the new host done over New Year's, 2006. The programming is still ongoing, and not all features are yet functional. Please be patient, as I also have a practice to run and a family to raise!
February 27, 2002
The American Academy of Orthopedic Surgery had its annual meeting in Dallas, Texas, from February 13-17, 2002. There was a meeting of eRadius members on February 15 at the Adam's Mark Hotel. We plan another at the next AAOS meeting in New Orleans, to be held February 5-9, 2003.
The AAOS has placed the handout from the Advances in Distal Radius Fracture Management online, and you can download it (in Adobe PDF format) here.
A thesis on distal radius fractures has been published on the web. It has a very interesting history of the development of treatment attitudes which I found quite good. I recommend it to you if you are a student of the distal radius.
February 2, 2002
Happy Birthday!
eRadius is celebrating its Fourth Year of Operation! It is a good time to look back to the beginning and to look forward to the future.
The Beginning
The site had its conceptual beginning in 1998, at the San Francisco International Distal Radius Course. The Course itself had its beginning in 1992, and over time the desire of surgeons throughout the world to meet to discuss distal radius fractures was more and more apparent. It was felt that there was a need to meet more frequently and to allow the dissemination of new knowledge as quickly as possible. The Internet seemed to be the ideal medium for instantaneous international communication, and the idea for eRadius was born.
The conceptualization and design started in 1998, a Board of Editors recruited, and the site was launched January, 1999. Site sponsors were found and the first year was a great success. There are now hundreds of pages on the site, and the site contains an number of unique and important resources that cannot be found anywhere else (see Jesse Jupiter's revision of his now classic paper on intra-articular step-offs and the first publishing anywhere of the IFSSH's review of distal radius classifications.)
As any webmaster knows, however, a website is a black hole for time and money. The sponsors for this site do not cover the cost of maintaining the site and the work involved soon overwhelms any one person's available time. We have come to a time where we must either expand or fold.
The Future
eRadius has now hired an assistant, Kate O'Shea, who comes to eRadius with a background in medical websites. This will allow more timely postings and more comprehensive material on the site. The website structure itself has been redesigned in a number of ways, and over the coming weeks a new case will be posted and a number of new features brought online. One exciting new development: any site visitor will soon be able to post cases for discussion, in a separate Members Section. The Guest Professor cases will continue to be the core of the site.
It is hoped that an expanded website will be a resource worthy of support and further educational grants secured.
There will be another San Francisco International Distal Radius Course on October 18-20, 2002, with Jesse Jupiter, MD, and Diego Fernandez, MD, as the keynote speakers.
Members of eRadius who are attending the American Academy of Orthopedic Surgery Annual Meeting in Dallas, Texas, are invited to a talk on external fixation of distal radius fractures by eRadius's webmaster, David Nelson, MD, at the Adam's Mark Hotel, City View Room 5, on Friday, February 15, from 5 to 7 pm. There will be refreshments provided.
November, 3, 2001
I have been busy with other Internet, distal radius, and general hand surgery projects. New cases will be posted soon. For now, the newest is a paper on the history of external fixation of the radius and current techniques. See it here.
San Francisco Course
The eRadius meeting, called the Fourth International San Francisco Distal Radius Fracture Course, was held November 10-12, 2000. The meeting was a great success, with attendees from the US, Britain, Sweden, France, Austria, Germany, and Brazil. The slide presentations and the syllabus will be placed on this site in the near future.
I have been rather busy with preparations for the course and have not posted a new Case of the Week for some time. The faculty have promised to send in new cases and a new Case of the Week should be posted within 2 weeks.
Update on the Bibliography
The article by Knirk and Jupiter (1986) has been one of the most important articles in the modern era of distal radius treatment. The conclusions of that article have been challenged by other authors, including Dr. Jupiter himself. I asked him if he would comment on his classic article in light of his present views. You can read his comments at Knirk JL, Jupiter JB: Intra-articular fractures of the distal end of the radius in young adults (scroll down to the reviews at the end of the abstract). I would like to acknowledge Dr. Jupiter's willingness to subject one of his own articles to review and revision; I think that it takes true academic courage to criticize one of your most famous papers.
We have a new sponsor: eTrauma
I am pleased to welcome another sponsor to eRadius: eTrauma. Despite the similarity in names, we are not related except by a devotion to the internet. This company makes a system to allow physicians to receive xrays or clinical photographs from their ER at home. Click the logo on the homepage to check it out. I am trying to get one installed in my ER. It may save some late night runs into the ER that are not needed!
The commercial support for this site is needed to offset the huge expenses associated with establishing and running the site. I would encourage others to try to place content on the net, but expect it to be a black hole for time and money. We accept sponsors, but no ads, and the sponsors have no input whatsoever into the content. The decisions as to content are made 100% by the Webmaster.
The Edinburgh International Trauma Symposium
http://www.trauma.co.uk
The Edinburgh International Trauma Symposium was established in 1987 with the aim of disseminating and discussing current philosophies of orthopaedic trauma management. The symposium has grown in size and in 2000 will be held in the Edinburgh International Conference Centre, Scotland between 16th to 18th August 2000. In 2000 the orthopaedic trauma themes will be Shoulder Injuires, Arthroscopy in Trauma, Knee Ligament Injuires, Fractures around the knee, bone morphogenic proteins, bone substitutes and soft tissue complications of diaphyseal fractures. This year there will be break-out sessions on trauma topics and also on the Orthopaedic Internet. The meeting has always been run on an informal basis and questions and discussion are encouraged. Several years ago an annual guest lecture was instituted and
this year we are fortunate to have Professor John Kenwright from Oxford University who will lecture on the "Mechanical influences of fracture union". The Symposium takes place in Scotland's historic and cosmopolitan capital during the three weeks of the Edinburgh International Festival. Throughout this period Edinburgh never sleeps! As well as the official festival the Fringe Festival, Book, Film and Television Festival all take place. Among the many visitor attractions, offering something for everyone are Dynamic Earth, the Museum of Scotland and the Former Royal Yacht Britannia. Interested in golf? Edinburgh and the Lothians have over 25 courses with many available to non-members. A Golf Pass is also available from the Tourist Board, offering discounts. Eating out is no problem! You will be spoilt for choice, with a wide range of restaurants and bistros as well as over 700 bars.
A full program is online at http://www.trauma.co.uk
October 17, 1999
Problems with Registration
Over 500 surgeons have registered on the site, so you should be able to do so as well. The usual problem is not following the directions posted on the site. If you are having a problem with registering with eRadius, you should do the following: (1) make sure that you have correctly entered your email address, and (2) make sure you are using the current edition of your browser (the current one is available to download for free on the web, just go to the website for your browser and follow the directions). If you make an error when entering your email address, the program cannot send you your ID number. This part of the registration process is necessary to keep out lawyers and patients, and to exclude anyone who "flames" in the discussion groups. If you have tried these and you still cannot get logged on, please email me (Webmaster) with the following information: (1) the type of computer you are using, (2) the browser and release that you are using, and (3) a complete description of what is happening when you try to register. The more complete your description, the better the chance that I can find the error and help you.
Biennial Distal Radius Course
The Distal Radius Course, held every two years since 1992, will next be held November 10-12 of 2000. Diego Fernandez has agreed to be the keynote speaker; Jesse Jupiter is also a lead speaker. Other speakers are being selected now. Members of the site will be notified when the faculty roster has been finalized.
New Cases on the Way
There are several new cases on the way, one of which should be up in the next day or two. Marc Garcia-Elias has reviewed all the answers that people have sent in, and he has analyzed them all. You should receive an email notice about it very soon.
September 1-4
American Society for Surgery of the Hand Boston, Massacheusetts
There were a number of excellent distal radius papers, including one by Jesse Jupiter using cancellous bone graft in correctional osteotomies of the distal radius. I think that this will change the way we do osteotomies. Use the navigation button to the left to go to Research, then to American Society for Surgery of the Hand.
August 31
International Wrist Investigator's Workshop Boston, Massacheusetts
The highlight of this conference, with respect to distal radius papers, was an excellent review of arthroscopy in the treatment of distal radius fractures. Use the navigation button to the left to go to Research, then to International Wrist Investigator's Workshop.
July 10
Xrays now available blown up, with little increase in loading time!
Starting with the July 12 Case of the Week, you will notice that the cursor changes to a hand when you place it over an xray or other graphic. If you double click it, the image will be shown enlarged. Let me know if you think that this feature is desirable, and if the image is large enough. The larger we make them, the slower they load, so we have tried to choose a happy medium.
May 30
Instructional Course Lecture from the AAOS:
Advances in Distal Radius Fractures
Be sure to hit the navigation button, Research (to the left on your screen) and see what is available. The lecture series noted above is available by hyperlink.
May 17
New Schedule
I have been working with the Board of Editors to ensure a better compliance with the goal of a case a week. We have not been reaching our goal. The Board has agreed to a timetable for submission of cases and we should be getting the cases up more frequently. There are two further cases in the process of being prepared (it takes a few hours to fix all the xrays, get the questions into place, etc), so we should have fresh material every week or every other week for a while. Have patience, keep checking back, and let your friends know about the site.
April 14
External Fixators and Internal Fixation Hardware
New papers have been added to Basic Knowledge: External Fixators and Internal Fixation. If you do not find your favorite hardware listed, please e-mail the company to contact me so we can add it to the lists. Note that the product name is a hyperlink to a photograph of the device and possible more: surgical technique, etc. This project is on-going, so there is much more to add.
April 10
The next posting is not specifically about distal radius fractures, but it is a well-known course and it is being organized by one of the Board of Editors. (The course last year was on distal radius fractures.)
Edinburgh International Trauma Symposium: August 18-20, 1999
The Edinburgh International Trauma Symposium has been held annually since 1987. Each year different aspects of trauma and its management are discussed by an invited faculty of International & United Kingdom Surgeons. In 1999 the main themes are fractures of the femur including proximal, diaphyseal and distal femoral fractures, the pathophysiology of reaming, osteoporosis and osteoporotic fractures, factors affecting tibial fracture outcome, muscle injury and the spectrum of orthopaedic trauma. The Symposium is held just before the Edinburgh International Festival (15 August - 4 September). During the summer festival Edinburgh never closes! In addition to the Arts Festival there are book, film and television festivals as well as the famous Fringe Festival (8 - 30th August), which is now larger than the established Festival. Edinburgh is also very close to St Andrews, the home of golf, and the City has over 25 golf courses many of, which are open to non-members. The meeting is
restricted to 275 delegates so please book early.
Scottish Orthopaedic Research Trust into Trauma ~ SORT-IT. This trust has been established to promote research into orthopaedic trauma in Scotland. All proceeds from the Trauma Symposium will go to SORT-IT
http://www.orthopaedic.ed.ac.uk/edtrauma.htm
We will try to keep you posted concerning other courses on distal radius fractures. Please send notices to Webmaster.
March 15
New Sponsor: Interpore Cross
I am please to welcome Interpore Cross to eRadius as a site sponsor. Most of you probably know Interpore as the maker of the bone graft substitute ProOsteon. They now have a new product, ProOsteon R which resporbs more quickly than the previous product. (I agree with this move, since I felt that the original ProOsteon took too long to remodel.) You can check them out at: http://www.interpore.com. You can see some photographs of their product Basic Knowledge, Types of Bone Graft Substitutes, ProOsteon.
March 14
Histology
The paper on Types of Bone Graft Substitutes, found under the Basic Knowledge navigation button on the homepage, has gotten its first histology and clinical case. See the Wright OsetoSet section under Mineral. The name "OsteoSet" is a hyperlink to some histology and xrays. Over time, as more companies send in their histology and graphics, more will be posted. (Mar 15: I just added Interpore's ProOsteon!)
New Sponsor: Primal Pictures
I am pleased to welcome Primal Pictures to eRadius. They are a very nifty outfit in Britain and publish the Interactive Hand, as well as other products. The Interactive Hand (I bought a copy, I love it) is a computer-based anatomy application, written by Prof D A McGrouther and Dr. P O'Higgins. It allows you to examine the anatomy of the hand at about 8 levels, from the skin level down to the bones and ligaments, and to rotate any of these illustrations 360 degrees. You may have seen their product at an orthopedics meeting: they have been at the AAOS for the last few years, and I imagine that they have been at many international shows (I also saw them at the International Federation of Societies for Surgery of the Hand in Vancouver last May). If you love anatomy, check it out at: http://interactive-anatomy.com.
March 21
Review of the Responses to the Questions for
Case of the Week, January 25, 1999
It was a very interesting project to review all of the responses e-mailed into the site, with a wide range of opinions (anyone surprised?) There were 19 respondents. Question 1 and 2: Most people (9) preferred the AO system for classification, but only two people actually classified it: A3.2. The others either called it an A3 or claimed to use the AO and then merely described the fracture. Five preferred the Universal Classification (including Bill Cooney, who helped to define this system) with all considering this extraarticular, reducible, and unstable. There were 4 votes for the Frykman classification, 3 for the "just describe it" approach (see below), and 2 for Melone. Interestingly, rarely did the respondents actually classify the fracture (Question 1) in the classification system they claimed to use (Question 2). That is, when asked to classify the fracture, they said one thing; when they were asked what classification they use, they said another.
Question 3: Sixteen felt it was unstable and 2 that it was stable. Almost all cited the dorsal comminution as the reason for instability; one cited the 30 degrees dorsal tilt.
Question 4: the treatment opinions were the most divided, with 7 feeling that closed reduction and xrays in a week being acceptable treatment, and 12 saying that operative treatment was the appropriate course. Even members of the Board of Editors were divided: Bill Cooney stated that the fracture needed "immediate ex fix" while Marc Garcia-Elias felt that a trial of casting was warranted, as long as close followup was done. The operative treatments recommended included ex fix and Kapandji pinning.
Most of my preferences should be fairly obvious, since I was the treating surgeon: I like the Fernandez classification, since it helps me to decide what to do in some cases and the AO is too detailed, with no inter- or intra-observer agreement. The IFSSH has opined that it is best to just describe the fracture, which is what Board Member Marc Garcia-Elias did (he was on that committee). I like this option as well and try to dictate both a Fernandez classification and a description for all of my cases. I felt the case was unstable and that closed reduction would not hold. I did a closed reduction in the ER (Board Member Mel Rosenwasser noted that you should always do this even if you think it is unstable, just to relieve some of the tension on the soft tissues, and I agree), but not as a trial of its stability. I felt it was unstable and planned operative treatment from the start.
One wag from Britain recommended the classification system of: Type 1, not too bad; Type 2, bad; and Type 3, really bad. He claims that this system is best because it is reproducible and enjoyable. Three surgeons thought there was a scaphoid fracture, but I think that is just the limitation of the CRT at 72 DPI: there was no scaphoid fracture.
This discussion was very instructive for me, and I hope this summary was for you.
February 26, 1999
New Sponsor: Etex
I want to welcome a new sponsor to the site, Etex. They make a in-situ hardening bone graft substitute/cement called alpha-BSM (in the same general class as Norian SRS and BoneSource) that is available for use in distal radius fractures in Europe and is under development for use in the US. See the discussion of bone graft materials in the Basic Knowledge section. We hope to be having an enhancement to this section soon, with histology of the various bone graft substitutes and text information, both available by hyperlink. We are awaiting the submission of the data from the companies.
February 24, 1999
Research page is now functioning
The Research page now has some offerings from the AAOS meeting. Try it out. I will be listing some material from the ORS once I get permission from authors. We will be having some color histology in a bit. I am looking for Corresponding Editors for the OTA and for SICOT. Contact me if you are interested in volunteering.
February 17, 1999
Discussion Group software
The discussion group software is now up and running. You can find it right after the two reviews in Last Week's Case. You can now post responses to the Guest Professor and the Editors.
Feburary 11, 1999
Anaheim: AAOS, ORS, and ISOST meetings, February 1-8, 1999
These meetings were very informative and a lot happened. I will try to post ASAP the abstracts from all of the meetings relative to distal radius fractures. There are many new things, especially in the area of bone graft alternatives. I spoke to a variety of companies and will post an updated table soon. Also, we expect to be able to post histology slides for most of the bone graft alternatives as well as other useful information.
The ISOST (Internet Society of Orthopedic Surgery and Trauma) meeting was very impressive. You can examine their work at their site: http://www.Orthogate.com. The group is working toward two goals: getting good scientific orthopedic content on the net and making it available (findable) to orthopedic surgeons. I was selected to serve on the Board of Directors along with 8 other surgeons. Dr. Eugene Sherry of Australia was elected President. Keep an eye on that site.
David L. Nelson, MD
San Francisco
Webmaster, eRadius.com
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