Retrospective Comparison of Percutaneous Fixation and Volar Internal Fixation of Distal Radius Fractures

A change in the practice of a single surgeon provided an opportunity for retrospective comparison of comparable cohorts treated with percutaneous fixation (17 patients) or a volar plate and screws (23 patients) an average of 30 months after surgery. The final evaluation was performed according to the Gartland and Werley and Mayo rating systems and the DASH questionnaire. There were no significant differences on the average scores for the percutaneous and volar plating groups, respectively: Gartland and Werley, 4 vs 5; Mayo, 82 vs 83; and DASH score 13 for both cohorts. Motion, grip, and radiographical parameters were likewise comparable. Volar internal plate and screw fixation can achieve results comparable to percutaneous fixation techniques in the treatment of fractures of the distal radius.     

Treatment of Distal Radius Fractures with Percutaneous Pinning and Pin-in-plaster

This article describes a modified technique that combines percutaneous pinning and casting. A prospective study was conducted on 54 patients with distal radius fracture who were treated with percutaneous Kirschner wire (K-wire) fixation and pin-in-plaster technique. The surgical indications of this technique included displaced extra-articular fracture, intra-articular fracture without significant comminution, and articular step-off less than 2 mm. The average radial height was 10.96 mm, and the volar tilt was 3.97 degrees on immediate postoperative radiographs. Upon removal of pin-in-plaster and percutaneous K-wires, the average radial height was 9.92 mm, and the volar tilt was 3.93 degrees . Bony union was achieved in all patients; the satisfaction rate was 90.7%. Pin-in-plaster technique is effective for maintaining reduction during bone healing. The procedure provides the ability to achieve anatomic reduction and then maintains this reduction through an adequate method of immobilization.     

经皮克氏针内固定治疗桡骨远端不稳定性骨折

目的研究经皮克氏针内固定治疗桡骨远端不稳定性骨折的疗效。材料与方法本组病例50例，其中男22例，女28例。平均年龄52岁(16～86岁)。骨折分类：Colles’骨折36例；Barton骨折10例；Smith骨折4例。手术方法C臂X线透视下手法整复满意后，由桡侧向尺侧作经皮3～4根克氏针内固定。结果本组63例，50例获随访，平均随访18个月(6～39个月)。疗效按Dienst功能评估标准：优31例，良15例，可4例，优良率占92％。结论经皮克氏针内固定治疗桡骨远端不稳定性骨折，是一种损伤小，缓解疼痛好，康复锻炼早，功能恢复满意的手术，且合并症少，医疗费用低，毋须住院。也是一种便于基层医院推广应用的治疗方法。     

外固定支架结合闭合复位有限内固定微创治疗桡骨远端AOC3型骨折的比较研究

目的比较闭合复位有限内固定结合外固定支架与单纯石膏外固定治疗桡骨远端AO C3型骨折的临床疗效。方法随访2005年6月～2010年10月36例桡骨远端AO C3型骨折,其中18例予以单纯石膏固定（石膏组）,18例采用外固定支架结合闭合复位有限内固定（支架组）。随访至术后24周,比较两组患侧临床功能（改良Gartland-Werley功能评分）及X线表现（改良Lidstrom-Radiographic评分系统）。结果所有患者均骨性愈合,无明显感染等严重并发症。术后24周,临床疗效（改良Gartland-Werley功能评分）：支架组腕关节屈（45.06±3.04）°,伸（52.83±2.94）°,桡偏（22.83±2.33）°,尺偏（36.33±5.29）°,旋前（51.67±4.16）°,旋后（44.89±4.13）°;石膏组屈（41.56±3.01）°,伸（49.56±3.58）°,桡偏（20.61±2.17）°,尺偏（31.22±5.35）°,旋前（46.33±4.12）°,旋后（41.33±2.93）°。X线表现（改良Lidstrom-Radiographic评分系统）：支架组桡骨高度（9.11±1.23）mm,掌倾角（16.00±2.40）°,尺偏角（16.39±1.79）°,关节面台阶（1.11±0.76）mm;石膏组桡骨高度（7.61±1.65）mm,掌倾角（13.44±2.48）°,尺偏角（12.67±3.83）°,关节面台阶（2.22±0.94）mm。各项指标支架组均显著优于石膏组（P〈0.01）。结论对于桡骨远端AO C3型粉碎性骨折,采用外固定支架结合闭合复位有限内固定是一种微创有效的方法,但需要注意桡神经浅支损伤等并发症。     

动力型外固定架治疗老年桡骨远端粉碎骨折

目的探讨使用动力型外固定架治疗老年桡骨远端粉碎性骨折的临床疗效。方法自2004年1月开始选择性地采用动力型外固定架治疗老年桡骨远端粉碎性骨折共22例23侧。其中男9例，女13例，年龄51～85岁，平均60．8岁。按AO／ASIF分型，均为C型骨折，其中C1型6侧，C2型8侧，C3型9侧。按受伤机制分：摔伤16例，高处坠落伤6例7侧肢体；开放性骨折5例，皮肤与软组织损伤较轻。受伤到治疗时间为2h～13d，平均4．3d。结果术后随访6420个月，平均12个月。解剖复位15例16侧肢体，功能复位7例；关节功能按Dienst功能评估标准进行评定，优15例16侧肢体，良4例，可2例，差1例，优良率为87．0％。无神经血管损伤、伤口感染及骨髓炎等并发症。结论采用动力型外固定架是治疗老年桡骨远端粉碎性骨折的一种较好的方法，其操作简单、固定可靠、疗效满意、并发症少。     

外固定支架结合经皮穿针固定治疗桡骨远端粉碎性骨折

目的探讨外固定支架结合经皮穿针固定治疗桡骨远端粉碎性骨折的临床疗效。方法采用外固定支架结合经皮穿针固定治疗桡骨远端粉碎性骨折病人32例,与同期行单纯钢板内固定治疗的32例患者进行回顾性病例对照研究。结果两组患者均恢复顺利,未发现外固定支架松动、骨折断端移位、钉道感染、肌腱损伤、关节炎等并发症。64例均获得随访,随访时间7.3（2～18）个月,所有患者均在6～8周X线显示骨折处明显骨痂形成,骨小梁通过骨折线后拆除外固定支架。术后掌倾角、尺倾角及桡骨轴向短缩长度较术前有明显改善（P〈0.05）,术前、术后组间各数据比较均无统计学差异（P〉0.05）。根据改良Mcbride评分和纽约骨科医院腕关节评估标准（1990年）,外固定组优15例、良14例、可3例,优良率90.6%;钢板组优12例、良14例、可6例,优良率81.2%;组间优良率比较无统计学差异（P〉0.05）。结论外固定支架结合经皮穿针固定治疗桡骨远端复杂性、粉碎性骨折具有操作简单,并发症少,复位效果好的优点,具有明显临床推广价值。     

Early Outcomes of Scapholunate Injuries With Concomitant Distal Radius Fractures

Background: There is limited literature regarding the treatment of concomitant scapholunate ligament (SL) injuries in acute distal radius fractures (DRFs). We hypothesized that surgical treatment of SL injuries in adult patients with DRFs leads to improved functional outcomes. Methods: A retrospective review was made of 42 adult patients who underwent surgical treatment of a DRF with a SL injury between 2005 and 2013. In all, 39 of the 42 patients sustained an intra-articular DRF (AO B or C). SL injury was diagnosed by SL diastasis > 3 mm on posteroanterior (PA) radiographs, magnetic resonance imaging, or with wrist arthroscopy. Patients were divided into 3 groups: 23 had a SL repair and were treated within 21 days of injury (acute), 8 underwent SL repair greater than 21 days from injury (subacute/chronic), and 11 did not undergo repair (non-operative). Median overall time to clinical follow-up was 5.1 years. Mayo Wrist Scores (MWS) and Disabilities of the Arm, Shoulder and Hand (DASH) scores were used to evaluate functional outcome. Results: Clinical outcomes measured by the MWS at final follow-up (6 months-12 years) showed no significant differences between the 3 groups. Of patients treated acutely, 17.3% had good to excellent MWS. MWS at 1-year follow-up was 68.4, 70, and 64 in the acute, subacute/chronic, and non-operative groups, respectively. DASH scores were 16.7, 14.3, and 11.8 in the acute, subacute/chronic, and nonoperative groups, respectively, at a mean of 7.8 years. Conclusions: At mid-term follow-up, all 3 treatment groups had similar DASH scores to the general population. There were no statistical functional differences between any of the groups based upon MWS or DASH scores.     

丹参川芎嗪注射液联合外固定术治疗桡骨远端骨折的临床效果

目的:探讨于桡骨远端骨折行外固定术后应用丹参川芎嗪中药制剂治疗的临床价值。方法:将 2017年 11月— 2019年 12月我院普外科收治的行外固定术治疗的 56例桡骨远端骨折患者资料进行回顾性分析,依据术后治疗方式不同,分为研究组( 28例)和常规组( 28例),观察两组治疗前后患肢肿胀指数、血清 D-二聚体、纤维蛋白原( FIB)及治疗后骨折功能恢复情况 DASH评分、骨折影像愈合所需时间、腕关节功能 Mayo评分及并发症(浅表感染、腕管综合征、慢性疼痛、血栓)发生情况。结果:治疗前,研究组于常规组的患肢肿胀指数、血清 D-二聚体与 FIB水平分别为( 2.15±0.56)分 vs(2.09±0.59)分、( 20.03±2.48)mg/L vs(19.79±2.50)mg/L、(14.13±3.08)g/L vs(14.39±3.12)g/L,差异无统计学意义( P＞ 0.05)。治疗后,研究组患肢肿胀指数、血清 D-二聚体与 FIB水平均低于常规组分别为( 0.43±0.11)分 vs(1.07±0.09)分、(3.74±0.21)mg/L vs(6.43±0.48)mg/L、(2.76±0.54)g/L vs(5.38±0.61)g/L,常规组 DASH评分与骨折影像愈合所需时间均高于研究组分别为( 45.37±8.56)分 vs(36.85±7.72分)、(11.54±2.16)周 vs(8.47±1.09)周,差异均有统计学意义;研究组的腕关节功能 Mayo评分优良率为 89.29%(25/28),高于常规组 64.29%(18/28),差异有统计学意义;研究组发生浅表感染、腕管综合征、慢性疼痛及血栓并发症的总例数为 3例,显著少于常规组的 10例,差异有统计学意义( P＜ 0.05)。结论:临床将丹参川芎嗪中药制剂用于桡骨远端骨折外固定术的患者,不仅具有减轻患肢的肿胀程度、缩短影像愈合时间、利于腕关节功能恢复等优势,还能改善凝血功能,减少各种可能并发症的发生。