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991.
Purpose of ReviewFractures of the proximal humerus (PHF) and distal radius (DRF) are among the most common upper extremity fractures in the elderly. Recent randomized controlled trials support non-surgical treatment. Evidence behind the best non-surgical treatment strategy has been sparse and raises questions as to when and how to initiate exercises. The purpose of this systematic review and meta-analysis was to assess the benefits and harms of early mobilization versus late mobilization and supervised versus non-supervised exercises therapy after PHF and DRF.Recent Findings15 published and 5 unpublished trials were included. Early mobilization after PHF resulted in better function with a mean difference (MD) of 4.55 (95% CI 0.00–9.10) on the Constant Shoulder Score. However, the MD was not found to be clinically relevant. No clear evidence showed that early mobilization after PHF had a positive effect on range of motion or pain. Neither did it lead to more complications. Furthermore, no eligible evidence was found supporting early mobilization to be superior to late mobilization after DRF, or that supervised exercise therapy was superior to non-supervised exercise therapy after PHF and DRF. The quality of evidence on all outcomes was found to be low or very low.SummaryEarly mobilization after PHF may have a beneficial effect on function. Due to the lack of clear evidence, there is an urgent need for future studies to determine the effect of early mobilization and supervised exercise therapy after PHF and DRF.Prospero ID number: CRD42020167656, date of registration 28.04.2020Supplementary InformationThe online version contains supplementary material available at 10.1007/s12178-021-09697-5.  相似文献   
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994.
We present a 12-year-old boy with a displaced fracture of the distal radial epiphysis type I according to the Salter-Harris classification. The distal radial epiphysis was completely dorsally displaced, while the distal ulna remained intact. The injury was result of a fall on the patient’s outstretched hand. Closed reduction was applied and the forearm was immobilized with a long arm cast.

In the radiological re-examination a week later, a complete re-displacement of the fracture was detected. Open reduction followed and interposed flexor tendons (flexor pollicis longus and flexor carpi radialis) were found in the anatomical position of the distal radial epiphysis. The displaced epiphysis was reduced and fixed with two Kirschner wires and a long arm cast for a period of 6 weeks.

The follow-up examination 2 years later showed that the movement range of the wrist joint was not limited and skeletal growth of the radius was not disturbed.

The failure of closed reduction in these fractures is due to anatomical obstacles such as periosteum, flexor tendons and pronator quadratus interposition. Repeated forceful manipulations to achieve closed reduction must be avoided because of the potential for a number of complications, such as growth arrest, compartment syndrome, and avascular necrosis of the epiphysis.  相似文献   
995.
《Acta orthopaedica》2013,84(6):878-883
Background?Vascularized soft tissue transfer may give better results of treatment of infected nonunions of the tibia.

Methods?6 patients with infected nonunion of the tibia and combined soft tissue (70–170?cm2) and bony (5–8?cm) defects underwent staged reconstruction. Initial surgery consisted of soft tissue and bone debridement, external fixation, filling of the bony defect with a gentamicin-impregnated cement spacer, and reconstruction of the soft tissue with a free microsurgical muscle flap and skin graft. Second-stage surgery consisted of removal of the cement spacer and osseous reconstruction with nonvascularized bone graft.

Results?All patients except 1 achieved full weight-bearing and radiographic consolidation after 7–10 months. This patient required repeated bone grafting and internal plate fixation to heal. There were no cases of recurrence of infection at the latest follow-up, after a mean of 3 (1.5–5) years.

Interpretation?Staged reconstruction with free vascularized soft tissue transfer and conventional bone grafting within a cement-induced membrane is a low-risk surgical strategy resulting in a high rate of bone healing.

?  相似文献   
996.

Background

The lack of structural support remains a challenge in the treatment of comminuted distal radius fractures. Calcium phosphate and calcium sulfate bone cement has been used in other fracture locations in addition to fixation and has been shown to allow for retention of reduction in difficult cases.

Methods

A case-control retrospective review of 34 consecutive distal radius fractures treated with surgery was performed with the patients classified by Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification. Complications and postoperative radiographs were evaluated.

Results

Cement was used in the most difficult cases. Radial height was retained in both groups. Volar tilt was significantly better in the cement group. There were no significant differences between the case and control groups for any complication. No complications related to the use of the cement were found.

Conclusions

The use of bone cement as an adjunct to fixation of distal radius fractures seems to include minimal risks and may afford a technical advantage in maintaining reduction during surgery for difficult fractures. Since there is an aspect of fracture difficulty that we cannot control for by using radiographic assessment alone, cement may provide an advantage over fixation without cement, despite similar outcomes. Bone cement can be part of the "tool box" for difficult distal radius fractures. Further study is necessary to define the technical advantages and limitations of each particular cement product.  相似文献   
997.
背景:尺骨茎突骨折是桡骨远端骨折最常见的合并损伤,一直未引起临床医师的足够重视,骨折不愈合的发生率很高。目的:观察尺骨茎突骨折对桡骨远端骨折愈合及腕关节功能的影响。方法:选择2011年1月至2012年12月急诊行手法整复及石膏固定治疗的桡骨远端骨折患者60例,均为AO分型A型,按照是否合并尺骨茎突骨折分为观察组和对照组,观察组30例,均合并尺骨茎突骨折;对照组30例,均不合并尺骨茎突骨折。治疗前两组的掌屈、背伸、桡偏、尺偏、旋前和旋后功能差异无统计学意义(P〉0.05)。比较两组治疗后6个月解剖学评分和功能评分的优良率,以及治疗前和治疗后6个月的腕关节功能。结果:观察组治疗后6个月的解剖学评分和功能评分优良率分别为66.67%和70.00%,对照组为90.00%和93.33%,对照组的优良率明显高于观察组(P〈0.05)。两组治疗后6个月的掌屈、背伸、桡偏、尺偏、旋前和旋后功能均较治疗前明显提高(P〈0.01),对照组较观察组提高更为明显(P〈0.01)。结论:尺骨茎突骨折对桡骨远端骨折的预后有一定影响,尤其对腕关节功能恢复影响较大,值得进一步研究。  相似文献   
998.
目的 评价骨质疏松症对桡骨远端不稳定骨折患者术后功能的影响.方法 84例桡骨远端不稳定型骨折患者,均采用掌侧锁定钢板行切复内固定术,术前骨密度检测明确是否存在骨质疏松症.根据患者术前骨密度值将患者分为2组:骨质疏松组(A组):43例患者,平均年龄65.7岁,平均T值-2.5SD;非骨质疏松组(B组):41例患者,平均年龄63.1岁,平均T值-0.8 SD.术后第4周及12个月采用Jakim评分标准评估腕关节.结果 84例病人术后均获随访,随访时间12个月~21个月,平均14.6个月.两组病例在术后4周及12个月进行主观指标、客观指标和放射学评分.第4周时,两组无统计学差异(P>0.05),但第12个月非骨质疏松组主观指标与客观指标的恢复均明显优于骨质疏松组(P<0.05).结论 不稳定桡骨远端骨折采用锁定钢板切复内固定术后可以获得满意的临床疗效,但术前存在的骨质疏松症可以影响桡骨远端骨折患者术后的功能.  相似文献   
999.
目的探讨掌侧锁定钢板结合外支架治疗c型桡骨远端不稳定骨折的临床疗效。方法应用T形或斜T形掌侧锁定钢板及跨腕关节外支架治疗24例c型桡骨远端不稳定骨折患者。结果22例获得随访,时间6~29个月。按Lidstrom评分系统行影像学评价:优12例,良7例,中3例。依据Cooney评分法对腕关节功能进行评价:优17例,良3例,一般2例。无严重并发症发生。结论.对C型桡骨远端骨折应用掌侧锁定钢板结合外支架治疗能够起到坚强固定和早期活动的作用,可较早恢复腕关节功能,临床效果良好。  相似文献   
1000.
Abstract

This is a randomised study to compare two types of osteosynthesis to mobilise wrists after distal fractures of the radius. Inclusion criteria were Older type 2 and 3 fractures. External fixation was managed with Hoffmann II compact non-bridging. Internal fixation was managed with Micronail. Patients were followed up for 12 weeks. The primary outcome was the results of the disabilities of arm, shoulder and hand (DASH) questionnaire. The secondary outcomes were answers to the patient-rated wrist evaluation (PRWE), grip strength, satisfaction, radial length, and volar tilt. Thirty patients were randomised to have external fixation and 31 to have internal fixation.There were no significant differences in DASH score. Internal fixation gave significantly better grip strength at five (p = 0.00) and 12 weeks (p = 0.03). The operating time was significantly shorter (p = 0.00) when non-bridging external fixation was used, and there were minor radiological differences. An activity-based costing analysis showed that external fixation cost three times more overall.  相似文献   
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