超关节外固定支架治疗桡骨远端C型骨折

目的研究超关节外固定支架治疗桡骨远端AO分型C型骨折的疗效。方法采用超关节外固定支架治疗桡骨远端C型骨折3l例。结果治疗后平均随访6．5个月。骨折愈合时间平均为6．5周。根据Jakim评分标准评定疗效，优14例，良12例，优良率为83．87％。结论超关节外固定支架治疗不稳定型桡骨远端关节内骨折具有操作简单、复位满意、固定坚强、功能优良的优点。     

Combined internal and external fixation of distal radius fractures

Combined internal and external fixation of distal radius fractures is used most commonly to treat injuries with joint surface or metaphyseal comminution. External fixation aids reduction intraoperatively and facilitates arthroscopic, per-cutaneous, or open manipulation of the fracture.Internal fixation maintains precise reduction of critical anatomy, principally the contour and orientation of the articular surface. Postoperatively the fixator functions as a neutralization device, preventing fracture collapse and decreasing the biomechanical demands on the internal fixation hardware. The combined technique exploits the benefits of both forms of fixation, allowing each to be used to full advantage in the treatment of complex distal radius fractures.     

桡骨远端C3型骨折不同治疗方法的回顾性研究

目的 探讨C3型桡骨远端骨折有效治疗方法.方法 对2017年6月-2018年7月收治的53例桡骨远端C3型骨折患者,分别采用闭合复位外固定架固定和切开复位锁定加压钢板内固定两种方法进行固定,其中外固定架组34例,内固定组19例,并按照两种治疗方法的复位标准和功能标准对优良率进行比较.结果 53例术后均获得随访,随访时间...     

Operative Therapie der distalen Radiusfraktur

Distal dislocated radius fractures are now mostly treated surgically. Closed reduction and internal fixation with Kirschner wires are increasingly giving way to internal fixation with screws or fixed-angle plates and to the use of the fixateur externe. For fractures with concomitant severe soft tissue injury treatment with a bridging external fixator and adequate soft tissue management are first necessary. External fixation is needed in addition, however, once soft tissue repair has been achieved by means of internal fixation with screws or K-wires, and the external fixator should remain in place until the fracture has started to heal. If possible preference should be given to the use of nonbridging fixators. Conservative treatment can now no longer be justified except for stable and nondislocated fractures. Arthroscopy/assisted reconstruction of the carpal articular surface is the subject of some controversy and is not yet accepted as a standard procedure.     

外固定架在桡骨远端不稳定骨折治疗中的应用

目的 总结桡骨远端不稳定骨折外固定架治疗的效果。方法 本组28例均采用外固定架固定，其中19例应用克氏针固定，4例因骨缺损较严重同时植骨。结果 随访时间3—22个月，按改良的Mcbride评分标准，远期疗效优良者25例，优良率89．28％。结论 桡骨远端不稳定骨折手法复位较困难，并因石膏外固定难以维持复位而常发生再移位。这类骨折应尽早手术复位，外固定架固定是理想的手术方法之一，术后配合合理有效的功能锻炼，可以获得较好的效果。对远期功能影响最大的因素是桡骨短缩程度和关节解剖复位的满意程度。     

桡骨远端C型骨折掌侧锁定钢板与外固定架的疗效比较

目的比较掌侧锁定钢板与外固定架治疗桡骨远端C型骨折的疗效。方法采用随机对照法,纳入2014年10月到2017年10月收治的桡骨远端C型骨折患者,随机分为两组,分别采用外固定架或者掌侧锁定钢板治疗。比较两组患者手术时间、术中出血量、骨折愈合时间、术后并发症发生率;比较末次随访时患者腕关节活动度、桡骨掌倾角、尺偏角;比较健、患侧握力比值和患侧腕关节Gartland-Werley评分。结果共纳入30例患者,其中外固定架组14例,掌侧锁定钢板组16例。两组患者术后均随访1年。结果显示,掌侧锁定钢板组手术时间长于外固定架组,术中出血量多于外固定架组,但末次随访时桡骨掌倾角、尺偏角恢复水平优于外固定架组(P<0.05);两组骨折愈合时间,末次随访时腕关节屈伸、旋转活动度,健、患侧握力比,患侧腕关节Gartland-Werley评分等,均未见明显统计学差异(P>0.05);两组患者均未发生术后并发症。结论对于桡骨远端C型骨折,外固定架治疗的手术风险小于掌侧锁定钢板,但会造成术后一定程度的复位丢失,然而这种复位丢失并不影响患者的腕关节功能恢复。     

Nonbridging external fixation for fractures of the distal radius.

OBJECTIVE: To assess the feasibility of using standard components from the small AO external fixator set to support fractures of the distal radius with a construct incorporating distal fixation in the periarticular radius fragment that would allow for primary mobilization of the wrist joint during fracture healing. METHODS: In a prospective pilot study of a nonbridging external fixator in early 2001, 6 consecutive cases of fracture in the distal radius presenting at a tertiary care centre, the Hamilton General Division of Hamilton Health Sciences, were compared with 6 historical controls treated with a standard bridging construct immobilizing the wrist. Both groups were or had been treated with closed reduction and external fixation of the distal radius under fluoroscopic control. Fracture alignment was measured on radiographs after healing and removal of the fixation devices; additional (secondary) outcome measures were pin-tract sepsis and implant loosening (treatment failure). RESULTS: Compared radiographically with controls, alignments after fracture healing were improved (and virtually anatomic) with use of the nonbridging external fixator. The incidence of pin-tract sepsis was similar in the 2 groups, neither of which included any treatment failures. CONCLUSIONS: Nonbridging external fixation of comminuted distal radius fractures can be accomplished safely and effectively. The results of this pilot study suggest that improved radiographic alignment may be achieved with this technique.     

外固定架治疗桡骨远端粉碎性骨折的疗效分析

目的:探讨闭合手法复位外固定架治疗桡骨远端粉碎性关节内骨折的临床疗效。方法:对29例桡骨远端粉碎性关节内骨折,通过外固定架的牵伸辅助复位,矫正桡骨的短缩、成角移位,恢复关节面的解剖关系,利用外固定架维持复位后的位置并进行功能练习。术后定期进行X线和腕关节功能的评价。结果:29例均获得随访,随访时间3~12个月,平均6.5个月。根据Aro功能评价:优9例,良17例,可2例,差1例,优良率89.66%。结论:外固定架能很好维持复位后的位置,恢复桡尺骨的相对长度和关节面的平整,使腕关节功能得到良好的恢复,因此是治疗桡骨远端粉碎性关节内骨折的有效方法。     

Reduction techniques in distal radius fractures

External skeletal fixation is an important minimal invasive procedure in the management of fractures at the distal end of the radius. Attention to detail is important not only in the recognition of indications and function of the external fixator but also in its specific application. To improve anatomical restoration (e.g. palmar tilt) multi-planar ligamentotaxis is recommended. The demonstrated dynamic fixator is easy to apply and the double ball joint facilitates reduction after mounting by multi-planar ligamentotaxis. This transarticular unilateral external fixation system permits restoration of anatomy with the wrist in neutral or extension, thereby allowing full flexion of the metacarpophalangeal joints, with fingers and wrist extensor tendons relatively relaxed. Multi-planar ligamentotaxis, combined with a limited approach for supplementary procedures (fixation of articular fragments and/or bone grafting) and with early wrist motion, offers an encouraging treatment option in the management of unstable distal radial fractures by providing better anatomical restoration, especially of the palmar tilt and reduces the risk of wrist and finger stiffness.     

External fixation of distal radius fractures

External fixation has been used for the treatment of distal radius fractures for more than 50 years. Although the fixator configurations have undergone considerable modification over time, the type of fixator itself is not as important as the underlying principles that provide the foundation for external fixation. Although volar plate fixation is currently in vogue, the indications for external fixation remain largely unchanged. Newer fixator designs have also expanded the traditional usage to include nonbridging applications that allow early wrist motion. The following discussion focuses on the myriad uses for external fixation as well as the shortcomings and potential pitfalls.     

外固定支架结合掌侧入路治疗桡骨远端关节面骨折

目的探讨外固定支架结合掌侧人路治疗桡骨远端关节面骨折的手术指征及临床疗效。方法2000年3月～2005年3月，收治桡骨远端关节面骨折28例，采用背侧外固定支架固定于功能位，掌侧入路以钢板或克氏针固定；骨皮质粉碎或松质骨压缩者予植骨。其中男21例，女7例；年龄18～54岁，中位年龄41岁。左侧4例，右侧24例。根据AO分型标准：C2型18例，C3型10例。合并月骨周围脱位1例。结果4例失访，24例获随访6～18个月，平均8．5个月。X线片示骨折均愈合，桡骨长度无丢失；掌倾角8～16°，平均11．2°，尺偏角19～28°，平均20．8°，均无丢失。按照改良Mcbride评分和纽约骨科医院腕关节评估标准，优16例，良5例，可3例，优良率87％。结论不稳定桡骨远端骨折以及闭合复位难以纠正者应手术治疗。掌侧入路固定能降低并发症，结合外固定支架可获满意复位及功能。     

Tangential views of the articular surface of the distal radius—aid to open reduction and internal fixation of fractures

Open reduction and internal fixation of comminuted, displaced intra-articular or potentially unstable fractures of the distal radius with plate and screws has increasingly become a favoured treatment. Intra-operative assessment of fixation with the help of an image intensifier has always been difficult because of the anatomy of the distal radius. Imaging of the implants placed as distal as possible to achieve satisfactory fixation often shows the screws to be penetrating the joint. We describe two new radiographic views of the wrist joint, which we used intra-operatively in ten patients undergoing open reduction and internal fixation of distal radius fractures. Screws were thought to have been penetrating the joint in the standard lateral views of all of them and in the standard antero-posterior views of eight of them.

However, no screw was seen penetrating the joint in these new views. It was hence possible to place the plate distal enough to enable the screws to engage the sub-chondral bone. We recommend the use of these views in the open reduction and internal fixation of distal radius fractures.     

桡骨远端骨折的治疗策略

桡骨远端骨折是常见骨折，也是容易受到忽视的骨折，治疗不当会产生明显的功能受限。我们根据桡骨远端骨折的AO分型，对不同骨折类型采取不同的治疗方案，并对患者进行随访，评价治疗效果，进而提出对此骨折的治疗方案。手法复位石膏托外固定适用于AO分型中A型和B1型的桡骨远端骨折。普通AO板钉固定的手术指征主要有3点：①AO分型中的A型骨折手法复位失败者，②AO分型中的B型骨折关节面移位明显者，③AO分型中的C1、C2型和部分C3型骨折。LCP板钉固定适于伴有严重骨质疏松的桡骨远端骨折和AO分型中的C2、C3型骨折。外固定架固定适用于粉碎性而无法行板钉固定的桡骨远端骨折。     

桡骨远端不稳定性骨折手术与保守治疗疗效比较

目的　评价桡骨远端不稳定性骨折外固定器治疗与石膏固定的效果。方法　将桡骨远端不稳定性骨折患者随机分为两组 ,分别采用外固定器治疗和手法复位石膏固定治疗。用Dionst标准行功能评估、Stewart标准行解剖学评估。结果　外固定器组复位质量和疗效优于石膏组 (P <0 0 5 )。结论　桡骨远端不稳定性骨折行外固定器治疗是一种安全、简便、实用的方法。     

Methodik und Ergebnisse der externen Fixation bei Radiusfraktur

Both the radiocarpal and distal radioulnar joints are often affected in “distal radius fractures”. The incidence of this injury increases markedly among women over the age of 40. Bearing the wide variety of distal radius fractures in mind, a fixation system should be used which permits trans- and extraarticular application and subsequent reduction by means of distraction, as well as wrist mobilization and corrective osteotomies. It is important that both reduction and position of the carpal bones can be checked. This is possible using the double ball joint configuration with carpal height dimensioning. The possibility of extraarticular fixation should always be considered. AO group A.2 and A.3 fractures with sufficiently large fragments are suitable for this procedure. In other cases, transarticular application is advised. Complementary measures are justified in the case where two or more cortices in AP and lateral X-rays are destroyed. They are also used to stabilize the joint surface. Large bone defects should be filled with corticospongeous material.     

Biomechanical efficacy of an internal fixator for treatment of distal radius fractures.

Despite the effectiveness of external fixation in the treatment of complex wrist fractures, the complication rate for this modality ranges from 20% to 62%. Common complications are related to the use of percutaneous metal pins and result in an average reoperation rate of 16%. In addition, external fixation is unable to prevent dorsal collapse of the radius or maintain the normal palmar tilt of the radiocarpal joint surface. This complication may predispose to posttraumatic wrist instability and arthritis. The problems with external fixation have prompted a search for a better treatment option. An internal fixator placed through limited incisions on the dorsal aspect of the radius and spanning the fracture site can, in theory, provide the benefits of external fixation without the associated morbidity. This study determined the biomechanical efficacy of internal fixators compared with external fixators using a standardized model for an unstable wrist fracture. Two commercially available metal plates were used as internal fixators. Biomechanical testing of the devices was done, and stiffness was determined. Results showed that the internal fixators were significantly stiffer than were the external fixators in axial loading. Failure in axial loading, specifically compression, is a consistent reason for loss of reduction in intraarticular distal radius fractures. The clinical implications of these results suggest that an internal fixator theoretically can prevent loss of reduction in the axial plane and maintain palmar tilt by acting as a rigid dorsal buttress. In addition, the use of an internal fixator potentially decreases the high morbidity associated with external fixation. Additional investigation into the clinical application of internal fixators for distal radius fractures is needed.     

Hybrid external fixation of unstable distal radius fractures: initial experience

Abstract External fixation of unstable fractures of the distal radius has been associated with many technical problems and complications. Hybrid external fixation has not been used in the clinical setting for distal radius fractures, but in theory this concept seemed reasonable. Our report of the first three cases of unstable Colles fractures describes the operative technique, as well as intraoperative hints and postoperative findings. The operation is fairly easy, mainly due to the possibility of intraoperative three-dimensional manipulation of the distal fragment. Postoperative stability was good, as no redisplacement was noted. The patients’ acceptance of the device was high. In the postoperative period, one patient developed superficial infection at the Kirschner wire-skin interface that resolved with local care and systemic antibiotics; the fixator was removed after 6 weeks while in the other, noncomplicated cases the hybrid external fixator was kept for 8 weeks. In one case, signs of overdistraction of bone ends were detected on the postoperative radiograph, but painless postoperative adjustments of the fixator restored normal anatomy with no further complications. For valuable conclusions we are currently studying incoming cases in a prospective fashion.     

HoffmannⅡ Compact外固定架结合有限内固定治疗桡骨远端粉碎性骨折

目的探讨HoffmannⅡCompact外固定架结合经皮克氏针有限内固定治疗桡骨远端粉碎性骨折的临床疗效。方法采用HoffmannⅡCompact外固定架加经皮克氏针有限内固定治疗桡骨远端粉碎性骨折32例。结果32例均获随访,时间5-18（8±1.3）个月,骨折均骨性愈合,愈合时间35个月。术前尺偏角为-13°-14°（11.0°±2.1°）,掌倾角为-28°-0°（-9.5°±1.1°）;去除支架后测量：尺偏角为18°-34°（22.5°±2.5°）,掌倾角为0°-21°（12.5°±2.1°）,桡骨轴向缩短基本恢复正常,其中1例C3型缩短2 mm。关节功能按Dienst标准进行评定：优11例,良19例,可2例。结论Hoffmann Ⅱ Compact外固定架结合有限内固定治疗桡骨远端粉碎性骨折操作简单、固定可靠、疗效满意、并发症少。     

外固定支架结合内固定治疗桡骨远端骨折合并同侧掌指骨骨折

目的探讨外固定支架结合内固定治疗桡骨远端骨折合并同侧掌、指骨骨折的临床疗效。方法对32例桡骨远端骨折合并掌、指骨骨折行Orthofix公司的超关节微型单侧多功能外固定支架结合内固定治疗。结果随访4～11月,平均5．2个月,骨折愈合时间6～12周,平均8周。腕关节功能按Sarmiento标准进行评定：优22例,良8例,可2例;按TAFS评分标准进行功能评估,优28例,良4例。结论对桡骨远端骨折合并掌、指骨骨折,采用超关节微型单侧多功能外固定支架结合内固定治疗,是一种安全实用、简便有效的治疗方法。     

不同方法治疗老年桡骨远端粉碎性骨折的比较研究

目的对比分析手法复位石膏外固定、有限内固定加外固定架固定和掌侧斜T形钢板内固定治疗老年桡骨远端粉碎性骨折的疗效。方法2000年1月～2004年9月,我院共收治178例60岁以上老年桡骨远端粉碎性骨折患者,手法复位石膏外固定102例,闭合或小切口复位克氏针有限内固定加外固定架固定46例,掌侧斜T形钢板内固定30例,随访比较不同治疗方法的疗效。结果所有患者随访13～52个月,平均27个月,按Dienst功能评估标准进行评定,手法复位石膏外固定组优良率为78.4%,有限内固定加外固定架固定组优良率为93.5%,掌侧斜T形钢板内固定组优良率为80.0%,有限内固定加外固定架固定组疗效明显优于石膏外固定及掌侧斜T形钢板固定组,差异有极显著性意义(P<0.01);石膏外固定与掌侧斜T形钢板固定组间疗效无显著差异(P>0.05)。结论对于老年桡骨远端粉碎性骨折,有限内固定加外固定架固定组疗效优于手法复位石膏外固定组和钢板内固定组。