Open treatment for displaced articular fractures of the distal radius

Fifteen patients with severely displaced Type 4 articular fractures of the distal radius required open treatment for the reduction and fixation of disrupted articular surfaces and for the repair of associated nerve, tendon, or arterial injuries. These patients were predominantly young men whose wrists had been exposed to violent compression forces. Five cases were rated excellent, nine good, and one fair according to the McBride and Lidstr?m systems of evaluation. In this study, distal radial fractures with wide displacement or rotation of the articular surfaces were treated by prompt and precise repair of skeletal and soft tissue damage.     

Less invasive surgery with wrist arthroscopy for distal radius fracture

Background

We developed a surgical procedure that can facilitate arthroscopic intervention for volar locking plate fixation for distal radius fracture (DRF) with a less invasive technique. This study is to investigate the effectiveness of our original procedure for the treatment of DRF.

Methods

One hundred fifty-five wrists of 153 consecutive patients underwent our original procedure: the plate presetting arthroscopic reduction technique (PART) for DRF. The fractures consisted of 37 extra-articular and 118 intra-articular fractures. The fractures were reduced, anatomical alignment was regained with the aid of an image intensifier, and the volar locking plate was preset. Wrist arthroscopy was then performed and the intra-articular condition assessed. If there were any residual dislocations of the intra-articular fragments, these were reduced arthroscopically, and soft tissue injuries were subsequently treated. The traction was then removed, and the plate was securely fixed. One hundred forty-five patients were followed up from 12 to 48 months. The final outcome was evaluated with the Mayo modified wrist score and Disability of the Arm, Shoulder and Hand questionnaire (DASH). The effectiveness of arthroscopy was also investigated.

Result

On arthroscopic inspection, intra-articular dislocations were found to be residual in 35.2 %, even if reduction seemed to have been achieved when viewed with the image intensifier. Scapholunate interosseous ligament injury was recognized in 28.9 %, and triangular fibrocartilage complex injury was observed in 63.2 %. The final outcome was 112 excellent, 31 good, and 2 fair. The mean DASH score was 4.1.

Conclusion

We developed the PART to simplify the combination of volar locking plating and arthroscopy. This technique was less invasive and effective in the treatment of DRF.     

折顶回旋法治疗桡骨远端骨折78例

桡骨远端骨折为上肢常见骨折。我科于2008年10月至2010年4月采用折顶回旋法治疗桡骨远端骨折78例,疗效满意,现报告如下。1临床资料本组78例,其中男26例,女52例;年龄24～83岁,平均58.5岁。其中Colles骨折68例,Smith骨折9例,Barton骨折1例(向掌侧移位)。摔跌伤71例,高处坠落伤4例,车祸伤3例;右侧41例,左侧34例,双侧3例。受伤时间30min～10d。2治疗方法2.1整复与固定患者仰卧位,肩外展90°,屈肘90°。Colles骨折:掌心向下,一助手双手握肘关节,另一助手用一手虎口     

Radio-radial external fixation in the treatment of distal radius fractures allows for free wrist motion

INTRODUCTION: Joint bridging external fixation in the treatment of distal radius fractures restores radial length, whereas anatomic reduction of articular fragments is difficult. Immobilisation of the wrist joint is a further disadvantage. An extraarticular hybrid fixation of distal radius fractures was introduced that facilitates fracture reduction, safe retention and allows for free wrist movement. METHODS: 30 consecutive patients with extra- and intraarticular comminuted fractures of the distal radius were treated with an extraarticular radio-radial external fixation employing a modified Ilizarov hybrid fixation technique. The operative procedure is described in detail. A clinical and radiological evaluation was carried out on the first and seventh day as well as 6 weeks postoperatively after implant removal. RESULTS: Anatomic reduction was achieved in 24 cases (80%). On the first postoperative day dorsiflexion was 30%, palmar flexion was 51% and pronation/supination was 60%/70% of the uninjured side. Six weeks postoperatively all fractures united. Wrist motion of the affected side was more than 80% of the unaffected side. Neither extensor tendinitis nor pin loosening in the distal fragment did occur. CONCLUSION: The technique of extraarticular hybrid fixation is safe and reliable in the treatment of comminuted fractures of the distal radius. It allows for early wrist movement in the immediate postoperative period.     

Assessment of articular displacement of distal radius fractures

Intraarticular step and gap displacements represent the most common indication for surgical treatment of distal radius fractures. Most often, treatment decision making relies only on good-quality plain radiographs taken before and after reduction with measurement accuracy maximized by using the longitudinal axis method. When plain radiographs alone prove insufficient, CT scans or tomograms will significantly improve interobserver and intraobserver reliability of measurements, especially when evaluated using the arc method. Tomography is an effective method for postoperative evaluation of fractures immobilized in splints or casts. The role of MRI in assessing intraarticular distal radius fractures is limited to confirming injuries to carpal ligaments or the triangular fibrocartilage complex. Intraoperatively, we use fluoroscopy to obtain 30 degrees cephalad posteroanterior views and as 22 degrees lateral views to best observe articular surface reduction. Our current operative indications include fractures with radiocarpal or distal radioulnar joint step or gap deformities greater than 1-2 mm, gross distal radioulnar joint instability, or those with extensive metaphyseal comminution rendering them particularly unstable after closed reduction. In general, we tend to lean toward operative fixation in younger, more active patients.     

Dynamic splinting in wrist extension following distal radius fractures

Background  

Wrist flexion contracture is a common pathology which presents secondary to distal radius fractures. Joint stability, restoration and early mobilization are frequently achieved through surgical treatment after such an injury. The purpose of this retrospective study was to evaluate the initial effect of dynamic splinting on wrist extension (active range of motion), in both surgical and non-surgical patients following distal radius fractures.     

Distal plate placement for distal radius fractures limits wrist motion

Purpose  

To investigate the influence of distal plate placement for distal radius fractures on risk of flexor tendon complications and wrist motion by performing hardware removal.     

桡骨远端粉碎骨折并关节面翻转的诊治体会

目的 探讨桡骨远端粉碎性骨折合并关节面翻转的诊断与治疗方法.方法 对4例(5侧)桡骨远端粉碎性骨折合并关节面翻转的患者,用CT断层扫描和三维重建技术进行诊断,采用外固定支架或结合有限内固定进行治疗.结果 术前3例获得确诊,1例(双侧)漏诊.术后4例获得6～30个月的随访,平均12个月.术前腕关节尺偏角为-10°～15°(平均12.5°),掌倾角为-25°～0°(平均-10°);术后尺偏角为20°～30°(平均25°),掌倾角为0°～20°(平均11.0°).按Dienst功能评估标准评定:优4侧,良1侧.术后无针道感染、针孔骨折、神经血管损伤、伤口感染及骨髓炎等并发症.结论 外固定支架结合有限内固定是治疗桡骨远端粉碎性骨折合并关节面翻转的有效治疗方法,其操作简单、固定可靠、并发症少、疗效满意.CT扫描和三维重建技术对诊断有一定的帮助.     

腕关节镜辅助下Kapandji技术整复桡骨远端Die-punch塌陷型骨折

目的探讨腕关节镜辅助下Kapandji技术整复桡骨远端Die-punch塌陷型骨折的治疗效果。方法自2012年1月至2018年12月,我们共收治31例桡骨远端Die-punch塌陷型骨折患者,骨折均经CT检查确诊,术中在腕关节镜视下用克氏针撬拨复位桡骨远端塌陷骨折块,达到关节软骨面基本平整,进一步检查腕关节内韧带,特别是舟月韧带、月三角韧带和三角纤维软骨复合体的损伤情况,并修复相应韧带损伤。本组骨折均用克氏针结合外固定支架固定。结果术中发现合并舟月韧带损伤5例、月三角韧带损伤2例、三角纤维软骨复合体损伤10例。术后患者伤口均Ⅰ期愈合,并获得随访,时间为6~24个月,平均11.3个月。骨折愈合时间为6?8周,平均7周。术后X线片测量掌倾角6°~17°,尺偏角15°~23°。腕关节功能按Gartland-Werley标准评定:优22例,良7例,可2例,优良率为93.5%。结论腕关节镜辅助下Kapandji技术整复桡骨远端Die-punch塌陷型骨折可准确复位塌陷的关节面,可减少创伤性骨关节炎并发症,又能明确腕关节内韧带和三角纤维软骨复合体等结构的损伤程度,便于早期处理,以防遗留慢性腕关节痛或不稳定。     

桡骨远端骨折的治疗现状

桡骨远端骨折是上肢骨折中最常见的骨折，约占整个骨科急诊骨折的1／6～1／4。人类对此种骨折的认识已有200多年的历史。Pouteau在1783年首先描述了这种骨折，1814年Abraham Colles详细描述了这种骨折的特点，并以Colles骨折命名。1838年Barton、1854年Smith、1887年Dupuytren等又分别详细描述了桡骨远端不同骨折类型的特点。     

Pilon fractures of the wrist. Displaced intra-articular fractures of the distal radius.

22 patients who sustained high energy wrist injuries are reported. These complex injuries resulted in articular disruption of the distal radius. Associated injuries included scapho-lunate dissociation (18%), central die-punch injuries (14%), ulnar fractures (41%) and diastasis at the distal radioulnar joint (23%). Nine fractures (41%) were open and almost a third of patients had other skeletal injuries. All patients were treated by external fixation and reviewed after a mean follow-up of 2 1/2 years. There were no excellent results and only ten good ones (45%). The mean functional impairment was 32%. The external fixator was effective in maintaining extra-articular alignment, but not in ensuring accurate reduction of the articular surface. Residual incongruity of the joint surface was an adverse prognostic feature. All five patients (22%) with an articular step of more than 2 mm. developed symptomatic arthritis. Failure to restore the joint line did not account for all the unsatisfactory results; persistent scapho-lunate dissociation and problems at the distal radioulnar joint were also important.     

The treatment of distal radius fractures using the external fixator]

This is a report on the stabilisation of fractures of the distal end of the radius type C2 and C3 and open fractures by external fixator. Between 1982 and 1989 38 patients with 43 fractures were treated. A follow-up was done 8 to 80 months after operation including 35 patients. 14 patients were polytraumatised. Especially in this group of patients, the advantages of this procedure can be seen. This advantages are a small stress for the patient, involving only a short time of assembling of the external fixator besides a high stability of the system. Our results show, as well as the results of the literature, that the external fixator has its place in a differentiated therapeutic concept of intraarticular fractures, open fractures and fractures with a defect of the distal radius.     

桡骨远端B型骨折

目的：探讨桡骨远端B型骨折腕关节镜直视下复位后予Herbert螺钉固定治疗的临床疗效。方法：2013年6月至2015年7月,采用腕关节镜直视下手法复位及撬拨复位Herbert螺钉固定同时修复关节内软组织损伤的方法治疗桡骨远端患者28例,男15例,女13例;年龄17～69岁,平均45.3岁;病程为伤后4～7d。受伤后患者具有典型桡骨远端骨折体征,X线片及CT明确诊断,并确定不合并其余部位骨折及神经血管损伤,不合并严重内科疾病,无手术禁忌证。按AO/OTA分型：B1型8例,B2型7例,B3型13例。随访观察骨折愈合情况及腕关节功能恢复情况,并评定疗效。结果：全部患者无手术并发症发生,28例桡骨远端B型骨折术后均获随访,平均随访时间（12.1±1.4）个月,骨折全部愈合,测量掌倾角（15.2±3.4）°,尺偏角（20.4±6.4）°。根据Cooney腕关节评分量表评估疗效,优21例,良5例,可2例。术中关节镜检合并舟月韧带撕裂3例,合并月三角韧带撕裂1例,合并TFCC损伤16例。结论：腕关节镜辅助下复位Herbert螺钉固定治疗桡骨远端B型骨折可使关节面平整度最大程度恢复,应用Herbert螺钉固定创伤小,术后恢复时间短,减少骨折后创伤性关节炎的发病,同时可对骨折合并关节内韧带及软骨损伤一并修复恢复关节稳定性,降低腕关节慢性疼痛的发生率。     

腕背伸肌支持带筋膜瓣在桡骨远端骨折背侧入路中的应用

目的：探讨腕背伸肌支持带筋膜瓣在桡骨远端骨折背侧入路中的临床应用。方法选择2010年6月至2015年6月我院收治的桡骨远端骨折需行背侧入路固定病人120例。按照就诊的先后顺序采用数字表法将病人随机分为两组,筋膜瓣组52例病人骨折复位固定后采用腕背伸肌支持带筋膜瓣对拇长伸肌腱进行转位,常规手术组68例病人仅采用常规骨折复位固定手术。术后随访观察并比较两组病人拇长伸肌腱并发症的发生率。结果本组120例病人均手术成功,均获得随访,随访时间为3~60个月（平均为16.2个月）。筋膜瓣组未出现肌腱并发症;常规手术组发生3例拇长伸肌腱炎,1例拇长伸肌腱断裂,肌腱并发症发生率为5.88%。筋膜瓣组的肌腱并发症发生率明显低于常规手术组,差异有统计学意义（P=0.075）。结论与掌侧入路钢板置入治疗桡骨远端骨折相比,背侧入路钢板置入固定后的肌腱并发症发生率较高,腕背伸肌支持带筋膜瓣可以很好地避免这一并发症,并且操作简单,值得推广使用。     

手法整复桡骨远端有骨块翻转的骨折6例

自2000—2002年手法整复桡骨远端有骨块翻转的骨折6例，取得满意效果。     

Calcium phosphate bone cement for treatment of distal radius fractures: a preliminary report

Distal radius fractures in osteoporotic patients are often complicated with a residual deformity and a subsequent stiff and painful wrist. The aim of this study was to evaluate the usefulness of calcium phosphate bone cement (CPC95) in the treatment of these fractures. Seven Colles type fractures in seven patients (all female; average age, 58 years) were treated. After a closed reduction, the fractures were fixed either by percutaneous pinning or by external skeletal fixation. The CPC95 was then injected into the cancellous bone defect through a small dorsal incision. The functional and radiological results were evaluated for up to 1 year. All patients were graded as good or excellent within 3 months, and all were graded as excellent at the final follow-up. The average duration of immobilization was 3.5 weeks. The overall shortening of the radius was 2.3 mm. In one patient, CPC95 extruded into the extensor tendon sheath and was surgically removed. Injection of CPC95 is a promising augmentation of osteosynthesis for distal radius fractures, although a prospective control study is mandatory to prove the usefulness of this material. The equipment and surgical technique should be refined to avoid the extrusion of CPC95. Received: October 30, 2000 / Accepted: November 6, 2001