目的 比较外固定支架与锁定加压钢板（LCP）治疗桡骨远端die-punch骨折的疗效及适应证。 方法 2007年1月－2011年1月，分别采用外固定支架和LCP治疗桡骨远端die-punch骨折32例36侧，其中LCP固定19侧，外固定支架固定17侧。两组患者性别、年龄、致伤原因、骨折分类、伤后至入院时间等一般资料比较差异无统计学意义（P＞0.05）。术中对塌陷的关节面均采取撬拨植骨的方法恢复桡腕关节，克氏针固定较大骨折块。比较两种方法手术前后掌倾角、尺偏角、桡腕关节面恢复情况、骨折愈合时间，术后腕关节活动范围等。 结果 两组患者手术切口均Ⅰ期愈合，无感染发生。患者术后均获随访，随访时间6～24个月，平均13个月。所有患者骨折愈合良好，愈合时间、术后6个月X线片掌倾角、尺偏角两组间差异均无统计学意义（P＞0.05）；术后6个月腕关节尺偏活动度分别为（20.8 ± 3.6）°和（18.0 ± 2.8）°，LCP组优于外固定支架组（P＜0.05）；LCP组和外固定支架组桡骨高度分别为（10.9 ± 2.8）mm和（13.4 ± 2.3）mm，Gartland-Werley评分分别为（5.3 ± 2.4）分和（8.4 ± 3.6）分，两组差异有统计学意义（P＜0.05）。 结论 对于桡骨远端die-punch骨折，LCP可提供有效固定及早期活动，但对于关节面的塌陷及桡骨高度的恢复，外固定支架固定可提供良好的支撑作用。对于严重die-punch骨折可联合运用LCP和外固定支架等技术。
Objective To investigate the surgical technique and preliminary effectiveness of closed reduction and internal fixation (CRIF) using antegrade elastic intramedullary nailing (ESIN) via a novel approach through the proximal radius for treating distal radius metaphyseal-diaphyseal junction (DRMDJ) fractures in children. Methods A retrospective analysis was conducted on 34 children with DRMDJ fractures who met the selection criteria and were treated between January 2020 and June 2023. There were 21 boys and 13 girls, aged 6-14 years (mean, 8.2 years). Injury causes included falls in 11 cases and sports-related trauma in 23 cases. Twenty-six cases were associated with ipsilateral distal ulnar fractures. All patients had failed initial closed reduction in the outpatient clinic. The time from injury to operation ranged from 1 to 15 days (mean, 4 days). All patients underwent CRIF using antegrade ESIN inserted via a novel approach at the proximal one-third of the radius. The operation time, intraoperative fluoroscopy frequency, fracture healing time, and complications were recorded. Fracture reduction was assessed immediately after operation on anteroposterior and lateral X-ray films for residual translation and angulation. Wrist function was evaluated using the modified Mayo wrist score. ResultsSurgery was successfully completed in all 34 children. CRIF with ESIN failed in 2 cases with associated ipsilateral distal ulnar fractures, requiring conversion to open reduction of the ulna. Operation time ranged from 15 to 56 minutes (mean, 21 minutes). Intraoperative fluoroscopy frequency ranged from 5 to 21 times (mean, 7 times). Immediate postoperative X-ray films showed residual translation of 0-15% on anteroposterior view and 0-10% on lateral view, and residual angulation of 0°-5° on both anteroposterior and lateral views. All children were followed up 6-18 months (mean, 12 months). There was no complication such as neurovascular injury, incision infection, or limitation of forearm rotation. Follow-up X-ray films showed no fracture displacement, implant loosening, delayed union, or nonunion. Fracture healing time ranged from 4 to 8 weeks (mean, 6 weeks). Implants were removed at 4-6 months postoperatively (mean, 5 months). At last follow-up, all fractures had achieved anatomic or near-anatomic healing. The modified Mayo wrist score ranged from 80 to 100 (mean, 94), with 27 excellent and 7 good results, yielding an excellent and good rate of 100%. Conclusion CRIF using antegrade ESIN via a novel approach through proximal radius is a safe and effective treatment for pediatric DRMDJ fractures, associated with few postoperative complications and excellent restoration of wrist function.
ObjectiveTo compare the effectiveness of external fixation and volar locking compression plate in the treatment of distal radius fractures of type C. MethodsBetween March 2012 and March 2013, 122 patients with distal radius fractures of type C were enrolled in the prospective randomized study. Fractures were treated by external fixation in 61 patients (external fixation group) and by open reduction and internal fixation using a volar locking compression plate in 61 patients (plate group). There was no significant difference in age, gender, fracture side, weight, height, body mass index, fracture type, and interval of injury and operation between 2 groups (P>0.05). The blood loss, operation time, hospitalization days, fracture union time, wrist function, and complications were compared between 2 groups. And the quality of reduction was observed, including volar tilting angle, ulnar deviation, radial height, and articular reduction. ResultsThe blood loss, operation time, and hospitalization days in plate group were significantly higher than those in external fixation group (P<0.05). All of the patients in both groups were followed up 12-28 months. Postoperative complications occurred in 4 patients (6.6%) of external fixation group (pin tract infection in 2 cases and radial nerve neuritis in 2 cases) and in 5 patients (8.2%) of plate group (wound infection in 1 case, carpal tunnel syndrome in 2 cases, and tendon rupture in 2 cases), showing no significant difference between 2 groups (P=0.500). The X-ray films showed fracture healing in all patients of 2 groups; the union time of plate group was significantly longer than that of external fixation group (P<0.05). At last follow-up, there was no significant difference in ulnar deviation and radial height between 2 groups (P>0.05), but the volar tilting angle of plate group was significantly larger than that of external fixation group (P<0.05). There was no significant difference in wrist function and articular reduction between 2 groups (P>0.05). ConclusionFor distal radius fractures of type C, the use of external fixation or volar locking compression plate can obtain satisfactory clinical outcomes, but the external fixation has the advantages of less invasion, shorter hospitalization days, minor complications, and faster fracture union.
ObjectiveTo systematically review the effects of associated ulnar styloid fracture on the prognosis of distal radius fracture. MethodsDatabases including PubMed, EMbase, The Cochrane Library (Issue 5 2013), CNKI, CBM and WanFang Data were searched up to May 2013 for collecting cohort studies about the effects of associated ulnar styloid fracture on the prognosis of distal radius fracture. According to the inclusion and exclusion criteria, related cohort studies were screened, data were extracted and cross-checked, and quality of included studies was independently evaluated by two reviewers. Meta-analysis was then conducted using RevMan 5.2 software. ResultsA total of 9 studies involving 1 020 patients were included. The results of meta-analysis showed that there was no significant difference in GartlandWerley score between patients with ulnar styloid fracture or not. Statistical significant difference was found in DASH score between the two groups (MD=2.71, 95% CI 0.26 to 5.16, P=0.03), which indicated that patients with ulnar styloid fracture got higher score in DASH score. ConclusionCurrent evidence shows that ulnar styloid fracture may affect the prognosis of patients with distal radius fracture. Due to the quality and quantity limitation of the included studies, the above conclusion needs to be further verified by more high quality studies in future.
Objective To investigate the effectiveness of distal radius core decompression in the treatment of chronic wrist pain caused by various etiologies. Methods A retrospective analysis was performed for the clinical data of 10 patients with chronic wrist pain treated with distal radial core decompression between January 2018 and December 2021. There were 6 males and 4 females with an average age of 37.4 years (range, 21-55 years). The disease duration ranged from 7 to 72 months, with an average of 26.5 months. Preoperative MRI examination showed that 10 cases had bone marrow edema at the distal radius on the affected side, and 8 cases had bone marrow edema in the carpal bones such as scaphoid and lunate bone. Among them, 3 patients had a history of wrist fracture, and 2 patients had Kienböck diseases (1 case each in stage ⅡB and stage ⅢA). Three cases were combined with triangular fibrocartilage complex (TFCC) type 1A injury. Two cases were combined with osteoarthritis, 1 of them was complicated with severe traumatic arthritis, the wrist arthroscopy showed that the TFCC was completely lost and could not be repaired, and the cartilage of the lunate bone and the ulnar head were severely worn.Visual analogue scale (VAS) score was used to evaluate the relief of wrist pain before operation, at 6 months after operation, and at last follow-up, and the range of motion of the affected wrist in dorsiflexion, palmar flexion, ulnar deviation, and radial deviation was measured. The degree of bone marrow edema was evaluated according to T1WI, T2WI, and STIR sequences of MRI. Results All the patients were followed up 12-22 months, with an average of 16.4 months. Except for 1 patient who experienced persistent wrist joint pain and limited mobility after operation, the remaining 9 patients showed significant improvement in pain symptoms and wrist joint mobility. The VAS score and range of motion of wrist dorsiflexion, palmar flexion, ulnar deviation, and radial deviation at 6 months after operation and at last follow-up were significantly improved when compared with those before operation, the VAS score and the range of motion of wrist ulnar deviation and radial deviation at last follow-up were further improved when compared with those at 6 months after operation, all showing significant differences (P<0.05). There was no significant difference in wrist dorsiflexion and palmar flexion between at 6 months after operation and at last follow-up (P>0.05). Bone marrow edema was improved in 6 patients on MRI at 6 months after operation, and was also improved in other patients at last follow-up. Conclusion For chronic wrist pain caused by a variety of causes, distal radius core decompression can directly reduce the pressure of the medullary cavity of the distal radius, improve the blood supply of the corresponding distal structure, significantly alleviate chronic wrist pain, and provide an option for clinical treatment.
Objective To compare the differences between volar and dorsal plate positions in the treatment of unstable fracture of distal radius. Methods From June 2000 to December 2006, 61 cases with fracture of distal radius weretreated, 27 males and 34 females aged 22-70 years (55.5 years on average), among which 18 cases were caused by traffic accidents and 43 cases falls. All cases were fresh closed fractures. All patients had AP and lateral X-ray films of the wrist preoperatively and 30 cases experienced CT scan. According to AO, there were 25 cases for B1, 18 for B2, 7 for B3, 7 for C1, and 4 for C2. All the cases were randomized into 2 groups: the wrist palmar group (group A, n=34) and dorsal group (group B, n=27), to perform volar and dorsal plate fixation, respectively. As to the measurement of fortune for the preoperative ruler and incl ination angle, group A were (—45.0 ± 53.0)º and (8.6 ± 3.1)º, respectively, and group B were (—40.0 ± 30.0)º and (7.3 ± 5.6)º, respectively. Preoperative radial shortened (12.0 ± 5.3) mm in group A, and (10.3 ± 4.2) mm in group B. Joint surface level was (4.3 ± 2.2) mm in group A, and (4.1 ± 3.3) mm in group B. Results All of the 61 cases were followed up for 6-27 months (16 months on verage). All the fractures were healed, the time to heal ing in group A was (8.2 ± 1.6) weeks, and in group B was (8.1 ± 1.2) weeks, and the difference was not significant (P gt; 0.05). As for the wrist function by Cartland-Werley scoring at the 8th week after operation, 7 cases were excellent, 10 good, and 17 poor in group A with the choiceness rate of 50.0%, while 7 cases were excellent, 11 good and 9 poor in group B with the choiceness rate of 66.7%. There was significant difference between the two groups (P lt; 0.01). And at the 24th week after operation, 21 cases were excellent, 9 good, and 4 poor in group A with the choiceness rate of 88.2%, while 18 cases were excellent, 5 good, and 4 poor in group B with the choiceness rate of 85.2%. There was no significant difference between the two groups (P gt; 0.05). As for radiological assessment by Sarmiento, device and palm incl ination angles in group A were (9.5 ± 3.1)º and (18.0 ± 8.2)º, respectively, and in group B were (11.0 ± 4.7) º and (16.0 ± 7.6)º, respectively. No radial shortening was found either in group A or in group B, and joint surface level in both groups were less than 1 mm. There was no significant difference between group A and group B in terms of all indicators postoperatively (P gt; 0.05), but there was significant difference when compared with preoperation (P lt; 0.001). With regard to comparison of postoperative compl ications between the two groups, there was no significant difference (P gt; 0.05) in early postoperative compl ications, but there was in long-term compl ications (P lt; 0.01). Conclusion The volar and dorsal plate positions may offer effective stabil ity for unstable distal radial fracture and early functional exercise. The volar plate position may influence the pronation function of the wris joint in the short run, while the dorsal plate position may cause more compl ications in the long run.
Objective To determine the cl inical results of locking plate system in the treatment of distal radial fractures. Methods From May 2004 to November 2006, 75 patients were treated with 2.4 mm locking plate system. There were 41 males and 34 females, with a mean age of 51 years old (range, 13-82 years old). The locations were left side in 34 casesand right side in 41 cases. The cause of injury was a low energy fall in 49 cases, fall ing from height in 14 cases, traffic accident in 6 cases and sports injuries in 6 cases. All patients were diagnosed as having closed fracture. According to Müller-AO classification, there were 14 cases(18.7%) of type A, 5 cases(6.7%) of type B, and 56 cases(74.6%) of type C. The time from injury to operation was 5 hours to 27 days (mean 6 days). Results A total of 75 patients were followed up at 3 months, 71 patients at 6 months, 68 patients at 1 year and 51 patients at 2 years. Heal ing by first intention of incision was achieved in 73 cases, and infection occurred in 2 cases. Fracture reduction failed at 1 month, 3 months and 6 months in 1 case, respectively; 1 case received plaster fixation and 2 cases received re-fixation and autograft of il ium; and fracture healed in 3 cases at last follow-up. Two patients complained of skin numbness at site of superficial branch of radial nerve after 1 day, 1 patient had wound pain after operation, and 1 patient had infection of tendon at 3 days and 5 days in 1 case respectively. At last follow-up, the ranges of motion of wrist joint were (80 ± 9)° for pronation, (86 ± 7)° for supination, (57 ± 10)° for dorsal flexion, (51 ± 13)° for palmar flexion, (18 ± 7)° for radial incl ination, and (28 ± 7)° for ulnar deviation. According to modified Green scoring, the results were excellent in 66 cases, good in 6 cases and poor in 3 cases. At last follow-up, according to Knirk criterion for osteoarthritis, there were 22 cases of grade I and 5 cases of grade II, and all were classified as type C. Conclusion Internal fixation of distal radial fractures with 2.4 mm locking plate system provided a stable fixation with good cl inical outcomes.
ObjectiveTo investigate and evaluate the effectiveness of the distal radius microplate locking plate for the treatment of displaced fracture of medial clavicle.MethodsBetween January 2013 and June 2017, 18 cases of obvious displaced fracture of medial clavicle were treated with distal radius microlocking plate. There were 10 males and 8 females, with an average age of 51.4 years (range, 18-88 years). Causes of injury included traffic accident injury in 15 cases, heavy object injury in 3 cases; all of them were closed injury. According to Edinburgh classification, 15 cases were ⅠB1 type and 3 cases were ⅠB2 type. Fracture displacement was 12-21 mm (mean, 16.3 mm). The time from injury to operation was 3-7 days (mean, 4.3 days). After operation, the clinical healing and complications of fracture were observed, and shoulder function was evaluated according to Rockwood’s scoring criteria.ResultsNo incisional infection, neurovascular injury, or other early complications occurred. All 18 patients were followed up 8-15 months (mean, 12 months). All fractures reached clinical osseous union, and the healing time was 8-24 weeks (mean, 16.6 weeks). Postoperative plate loosening occurred in 1 case, which was removed surgically, while other patients did not suffer from complications such as bone nonunion, displacement, internal fixator loosening, and loss of reduction. At last follow-up, according to Rockwood’s scoring criteria, the results were excellent in 12 cases and good in 6 cases.ConclusionThe distal radius microplate locking plate is effective for the treatment of displaced medial clavicle fracture, which has few complications, and is feasible for early functional exercise, and is helpful for the recovery of shoulder joint function.