Ankara Training and Research Hospital, Department of Second Orthopaedics and Traumatology, Ankara, Turkey.
Injury. 2010 Feb;41(2):197-203. doi: 10.1016/j.injury.2009.08.021. Epub 2009 Sep 26.
In distal radial fractures in adults, factors affecting instability have been investigated in many studies in an effort to shorten the preoperative waiting period for the fractures requiring surgery. Numerous factors, aside from the alignment-related indices, have been searched to predict redisplacement. Unlike as in paediatric counterparts, the casting technique and casting-related indices have not been appropriately considered in adults. The aim of this study was to determine the impact of the various previously investigated factors in addition to casting technique-related indices such as three-point index, cast index, padding index and gap index, in predicting the risk of redisplacement of extra-articular distal radial fractures in adults and the presence of the ulnar deviation of the cast.
Seventy-five patients over 18 years who were treated with a cast in our emergency department within 24h after a displaced distal radial fracture, were recruited into the study. Age, alignment-related indices, cast-related indices, extent of the ulnar deviation of the cast, having a non-anatomical reduction, co-existing ulnar fracture, dorsal comminution and obliquity of the fracture line were investigated. Casting technique according to three-point index, obliquity of the fracture line, degree of the ulnar deviation of the cast, and reduction accuracy were the significant factors affecting redisplacement.
The three-point index had a sensitivity of 95.8%, specificity of 96.1%, positive predictive value of 92%, and negative predictive value of 98% in predicting redisplacement. Logistic regression revealed that having an inadequate cast according to the three-point index (p<0.001), degree of obliquity of the fracture line (p=0.018), decreased ulnar deviation of the cast (p=0.002), and having a non-anatomical reduction (p=0.029) were the significant predictive factors in redisplacement.
Our results suggest that the casting technique plays a major role in the success of conservative treatment, which can best be examined with the three-point index. Ulnar deviation of the cast and fracture obliquity are the other dominant factors affecting redisplacement.
在成人桡骨远端骨折中，为了缩短需要手术的骨折患者的术前等待时间，许多研究已经在探讨影响不稳定的因素。除了与对线相关的指数外，已经研究了许多其他因素来预测再移位。与儿科病例不同，在成人中，并未适当考虑到固定技术和与固定相关的指数，如三点指数、固定指数、填充指数和间隙指数。本研究旨在确定除了与固定技术相关的指数（如三点指数、固定指数、填充指数和间隙指数）之外，各种先前研究的因素，以及桡骨远端关节外骨折成人患者固定的尺侧偏移的存在，对预测再移位的风险的影响。
本研究共纳入 75 名 18 岁以上的患者，这些患者在桡骨远端骨折发生后 24 小时内于我院急诊接受了固定治疗。研究人员调查了患者的年龄、与对线相关的指数、与固定相关的指数、固定的尺侧偏移程度、非解剖复位、合并尺骨骨折、背侧粉碎性骨折和骨折线的倾斜度。根据三点指数、骨折线倾斜度、固定的尺侧偏移程度和复位准确性，对固定技术进行评估，这些都是影响再移位的重要因素。
三点指数在预测再移位方面具有 95.8%的敏感性、96.1%的特异性、92%的阳性预测值和 98%的阴性预测值。逻辑回归显示，三点指数提示固定不当（p<0.001）、骨折线倾斜度增加（p=0.018）、固定的尺侧偏移减小（p=0.002）和非解剖复位（p=0.029）是再移位的显著预测因素。
我们的研究结果表明，固定技术在保守治疗的成功中起着重要作用，而三点指数是评估固定技术的最佳方法。固定的尺侧偏移和骨折线倾斜度是影响再移位的其他主要因素。
