Injury (1992) 23,(61, 429 Printed in Greaf Britain
427
letters to the Editor
Undisplacedfracturesof the distal third of the radiusin children:an innocentfracture?
Author’s reply
Dear Sir I wish to deprecate the choice of the above title for this very interesting recent paper in your journal (Injury 1992; 23:
Dear Sir We are very pleased to see that Mr Gunn found our above paper interesting and are grateful for the opportunity to reply to his letter. We chose the term ‘distal third as it was the terminology used in the reference articles we consulted, but we also agree that the present terminology is inadequate. We would agree that terminology soundly based on anatomy should be adopted where possible, but where does the shaft end and the end begin. If in children the end implies the epiphysis then this term would not be appropriate as we specifically excluded epiphyseal injuries in our study. Mr Gunn has correctly pointed out that most of our fractures involved the distal metaphysis. Is the metaphysis the distal part of the shaft or the proximal part of the distal end? Despite the persistent confusion in terminology when referring to the fracture site, we hope that your readers accept the importance of using the appropriate terminology to refer to the fracture type, i.e. dorsal or volar, unicortical or bicortical, cortical breach or buckle. This may have clinical management implications as I hope our paper has shown.
165-167). I regret
that the term ‘distal third was used because fracture of the distal third of the radius which has not been defined by anatomical landmarks but by a tape measure are a heterogenous collection. In the upper half of the lower third fractures must surely be fractures of the shaft. At the distal end of the radius in children fractures may involve the metaphysis, the epiphyseal plate, epiphysis or joint. Gray’s anatomy states that a long bone consists of a shaft and two ends. I feel sure that we ought to preserve the distinction because the problems of diagnostic treatment of fractures of the shaft of the radius are quite different from the problem of the lower end of the radius. I do not see that your authors define the site of fracture but their illustration suggests that all or most of these fractures are in the distal metaphysis of the radius. I hope that authors will in future adopt terminology soundly based on anatomy.
A. L. Gum
0 1992Butterworth-Heinemann 0220-1383/92/060429-01
Ltd
FRCS
P. J. !khranZ FRCSEd Orth
P. S. Fagg
FRCS
427
letters to the Editor
Undisplacedfracturesof the distal third of the radiusin children:an innocentfracture?
Author’s reply
Dear Sir I wish to deprecate the choice of the above title for this very interesting recent paper in your journal (Injury 1992; 23:
Dear Sir We are very pleased to see that Mr Gunn found our above paper interesting and are grateful for the opportunity to reply to his letter. We chose the term ‘distal third as it was the terminology used in the reference articles we consulted, but we also agree that the present terminology is inadequate. We would agree that terminology soundly based on anatomy should be adopted where possible, but where does the shaft end and the end begin. If in children the end implies the epiphysis then this term would not be appropriate as we specifically excluded epiphyseal injuries in our study. Mr Gunn has correctly pointed out that most of our fractures involved the distal metaphysis. Is the metaphysis the distal part of the shaft or the proximal part of the distal end? Despite the persistent confusion in terminology when referring to the fracture site, we hope that your readers accept the importance of using the appropriate terminology to refer to the fracture type, i.e. dorsal or volar, unicortical or bicortical, cortical breach or buckle. This may have clinical management implications as I hope our paper has shown.
165-167). I regret
that the term ‘distal third was used because fracture of the distal third of the radius which has not been defined by anatomical landmarks but by a tape measure are a heterogenous collection. In the upper half of the lower third fractures must surely be fractures of the shaft. At the distal end of the radius in children fractures may involve the metaphysis, the epiphyseal plate, epiphysis or joint. Gray’s anatomy states that a long bone consists of a shaft and two ends. I feel sure that we ought to preserve the distinction because the problems of diagnostic treatment of fractures of the shaft of the radius are quite different from the problem of the lower end of the radius. I do not see that your authors define the site of fracture but their illustration suggests that all or most of these fractures are in the distal metaphysis of the radius. I hope that authors will in future adopt terminology soundly based on anatomy.
A. L. Gum
0 1992Butterworth-Heinemann 0220-1383/92/060429-01
Ltd
FRCS
P. J. !khranZ FRCSEd Orth
P. S. Fagg
FRCS
