Traitement orthopédique des fractures distales de l’ulna associé à une ostéosynthèse distale radiale chez le patient âgé

Abstract

IntroductionAlthough volar locking plates (VLPs) have been exclusively used for unstable distal radius fractures (DRFs), the optimal management of distal ulna fractures (DUFs) remains controversial. Internal fixation using a plate for DUFs might be challenging because of the presence of osteoporotic bone and fragile bone fragments in elderly patients. HypothesisWe hypothesized that a strategy including VLP fixation for DRFs and non-intervention for DUFs with early wrist mobilization would provide encouraging results in elderly patients. Materials and methodsEighteen patients (17 women and one man, mean age 74.7 years) were included in the study. According to the Biyani classification, there were seven patients with type-1, three with type-2, five with type-3, and three with type-4 DUFs. Radiological results were analyzed in 18 patients and the clinical results could be evaluated in 10 patients who attended the necessary follow-up meetings. Ulnar angular deformity (UAD) and ulnar shortening amount (USA) were measured using anteroposterior radiographs. USA was defined as the difference in ulnar variance between just after surgery and at the final visit. Clinical results were assessed using the modified Gartland and Werley score, disability arm shoulder hand (DASH) score, range of motion, grip strength, pain, and distal radioulnar joint (DRUJ) instability. ResultsAll ulna metaphyseal fractures united. The mean UAD just after surgery was 5.9° (range, 0–22). At the final visit, the mean UAD was 6.4° (range, 0–17). The mean USA was 0.35mm, and only one patient showed ulnar shortening of>2mm. The results were “excellent” in nine patients and “good” in one, according to the modified Gartland and Werley score. The mean DASH score was 4.2. Mean flexion and extension angles were 58° and 71°. One patient complained of ulnar-sided pain during exertion and no patients complained of DRUJ instability. DiscussionAll DUFs achieved good radiological results, including comminuted fractures. Functional outcomes were promising, including wide wrist ROM and no DRUJ instability. An approach including VLP fixation for DRFs and non-intervention for DUFs is a good option for elderly patients. Level of evidenceIV retrospective study.