Barton Tristan, Chambers Charles, Lane Emma, Bannister Gordon
Department of Orthopaedics, Frenchay Hospital, Flat 6, 87 Hampton Park Redland, Bristol BS6 6LQ, Frenchay Road, Bristol, UK.
Injury. 2005 Dec;36(12):1431-4. doi: 10.1016/j.injury.2005.09.004. Epub 2005 Oct 27.
Fifty-three patients underwent closed reduction and longitudinal k-wiring of displaced Colles' fractures and were reviewed after a mean of 26 months. Radiographs taken at the time of injury, after reduction and k-wiring, and at fracture union were compared for radial shortening and dorsal angulation. Manipulation significantly improved fracture position (P<0.001). Dorsal angulation was successfully corrected by manipulation in 98%, and this position was maintained to fracture union in all cases. Seventy-three percentage of fractures manipulated for radial shortening >2 mm were adequately reduced, but 41% of these fractures subsequently lost position to malunite. In this group of patients, the mean radial shortening between reduction and fracture union was 1.6 mm. This did not correlate with Frykman Class or radial shortening at injury. Closed reduction and k-wire stabilisation is an attractive technique because it is relatively non-invasive compared with plating or external fixation. However, a degree of radial shortening between reduction and fracture union must be anticipated. Fractures reduced inadequately to allow for this loss of radial length, are more likely to malunite. This may compromise functional outcome.
53例患者接受了闭合复位及纵向克氏针内固定治疗移位的科雷氏骨折，平均随访26个月。比较了受伤时、复位及克氏针内固定后以及骨折愈合时的X线片，以观察桡骨短缩及背侧成角情况。手法复位显著改善了骨折位置（P<0.001）。98%的患者通过手法成功纠正了背侧成角，且所有病例中该位置维持至骨折愈合。对于桡骨短缩>2 mm而进行手法复位的骨折，73%得到了充分复位，但其中41%的骨折随后出现了复位丢失而畸形愈合。在这组患者中，复位至骨折愈合期间的平均桡骨短缩为1.6 mm。这与弗赖克曼分类或受伤时的桡骨短缩无关。闭合复位及克氏针固定是一种有吸引力的技术，因为与钢板固定或外固定相比，它相对无创。然而，必须预料到复位至骨折愈合期间会有一定程度的桡骨短缩。复位不充分而无法适应这种桡骨长度丢失的骨折，更有可能畸形愈合。这可能会影响功能预后。
