Comminuted Fractures Of Distal Radius Research Articles

Treatment of comminuted distal radius fractures by external fixator combined with internal fixation with K-wire and bone graft

目的 探讨应用组合式外固定器结合内固定加植骨治疗桡骨远端关节内粉碎骨折的疗效.方法 1999年9月-2005年4月,应用组合式外固定器结合克氏针内固定加植骨术治疗桡骨远端严重关节内粉碎骨折15例.结果 术后15例X线片显示:关节面分离和错位＜1.0mm 9例,＜2.0mm 6例;掌倾角为0°～10°,尺倾角20°～30°,15例均无骨短缩.骨折均全部愈合,临床愈合时间为6～10周.13例获得8～18个月随访,2例失访,按Dienst功能评定标准评定:优6例,良8例,可1例.结论 组合式外固定器结合内固定加植骨是治疗桡骨远端严重关节内粉碎骨折的有效方法。

Internal Distraction Plating of Distal Radius Fractures

Internal distraction plating can be used for the treatment of highly comminuted distal radius fractures especially in elderly patients. The technique involves the use of 3.5, 2.7, or 2.5 dynamic compression plates. The instrumentation is applied in distraction dorsally from the radial diaphysis, bypassing the comminuted segment, and fixed distally to the long metacarpal. The advantages of this technique are: a) it can be used as an alternative for managing difficult fractures in the elderly population; b) it is indicated in patients with osteoporotic bone; c) complications associated with external pins are avoided; and d) the stability of the plate allows patients to use the extremity for transfer and activities of daily living. On the other hand, possible disadvantages to be considered are: a) the need of a second operation to remove the plate; and b) the prolonged duration of immobilization. Elderly patients with osteoporotic bone who undergo treatment of comminuted distal radius fractures may result in poor outcomes with high rates of complications if external fixation or standard internal fixation is used. The current approach represents an alternative that provides union of the fracture with excellent alignment, functional range of motion, and minimal functional disability.

DORSAL PLATING FOR COMMINUTED INTRA-ARTICULAR FRACTURES OF THE DISTAL END OF THE RADIUS

Forty-one dorsally displaced intra-articular fractures of the distal radius were treated by open reduction and internal fixation with the dorsal Symmetry plates. The average age at the time of the injury was 49 years. An average follow-up period was 15 months. The final radial length averaged 11 mm, radial inclination 23 degrees, volar tilt 7 degrees, ulnar variance 1.5 mm, and articular incongruity 0.3 mm. According to the Gartland and Werly scales, 36 fractures were excellent and five were good. However, ulnar variance increased more than 3 mm during follow-up in eight patients, and volar tilt increased more than 5 degrees during follow-up in ten patients. Use of dorsal Symmetry plate is effective for unstable comminuted intra-articular distal radius fractures, but severely comminuted fractures may possibly undergo re-displacement post-operatively.

Use of the Clyburn External Fixator in fractures of the distal radius.

A study was organized to evaluate the use of a one-plane external fixation device to treat comminuted fractures of the distal radius. Clinical and roentgenographic data were obtained in 20 patients with a followup ranging from 12 to 20 months. The results were graded 14 excellent, 4 good, 2 fair, and none poor. The use of the Clyburn External Fixation Device with supplemental radial styloid Kirschner wire fixation achieved acceptable results in the treatment of comminuted distal radius fractures and proved to be easily applied.