Ring David, Rhim Richard, Carpenter Creg, Jupiter Jesse B
Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA 02114, USA.
J Hand Surg Am. 2006 Jan;31(1):17-21. doi: 10.1016/j.jhsa.2005.09.003.
In contrast to isolated diaphyseal fractures of the ulna (so-called night-stick fractures), isolated fractures of the radial diaphysis generally are expected to have associated injury of the distal radioulnar joint (DRUJ), the so-called Galeazzi fracture. This study retrospectively reviewed isolated fractures of the radial diaphysis in a large cohort of patients to determine how often such fractures occur without DRUJ injury
Thirty-six patients with fracture of the radius without fracture of the ulna were followed up for at least 6 months after injury. Injury of the DRUJ was defined as more than 5 mm of ulnar-positive variance on radiographs taken before any manipulative or surgical reduction. All of the fractures were treated with plate and screw fixation (8 with autogenous bone grafting) and all healed. Patients with DRUJ injury had either temporary pinning or immobilization of the DRUJ or surgical fixation of a large ulnar styloid fracture. Patients without DRUJ injury were mobilized within 2 weeks.
Nine patients had dislocation of the DRUJ, 4 with large ulnar styloid fractures. Among the remaining 27 patients 1 had displacement of the proximal radioulnar joint noted after surgery, leading to a secondary procedure for radial head resection. The functional results were satisfactory or excellent in all but 2 patients with functional limitations related to central nervous system injury. No patient had DRUJ dysfunction at the final follow-up evaluation.
Isolated fractures of the radial diaphysis are more common than true Galeazzi fractures. Surgeons should take great care not to overlook injury to the distal or proximal radioulnar joint in association with isolated diaphyseal fractures of the radius; however, fractures without identifiable radioulnar disruption can be treated without specific treatment of the DRUJ and with immediate mobilization.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic, Level IV.
与单纯尺骨干骨折（所谓的警棍骨折）不同，桡骨干单纯骨折一般预计会合并下尺桡关节（DRUJ）损伤，即所谓的盖氏骨折。本研究回顾性分析了一大组患者的桡骨干单纯骨折情况，以确定此类骨折在无DRUJ损伤时的发生频率。
36例桡骨骨折而无尺骨骨折的患者在受伤后至少随访6个月。DRUJ损伤定义为在任何手法或手术复位前拍摄的X线片上尺骨正向变异超过5mm。所有骨折均采用钢板螺钉固定（8例采用自体骨移植），均愈合。DRUJ损伤的患者采用DRUJ临时克氏针固定或制动，或对大的尺骨茎突骨折进行手术固定。无DRUJ损伤的患者在2周内开始活动。
9例患者发生DRUJ脱位，4例合并大的尺骨茎突骨折。其余27例患者中，1例术后发现近端桡尺关节移位，需行桡骨头切除术的二次手术。除2例因中枢神经系统损伤导致功能受限的患者外，所有患者的功能结果均为满意或优秀。末次随访评估时无患者出现DRUJ功能障碍。
桡骨干单纯骨折比真正的盖氏骨折更常见。外科医生应格外小心，不要忽视与桡骨干单纯骨折相关的下尺桡关节或近端桡尺关节损伤；然而，对于无明显桡尺关节破坏的骨折，无需对DRUJ进行特殊治疗，可立即活动并进行治疗。
研究类型/证据水平：治疗性研究，IV级。
