Tan Virak, Bratchenko Walter, Nourbakhsh Ali, Capo John
Department of Orthopedics, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark, NJ 07103, USA.
J Hand Surg Am. 2012 Mar;37(3):460-468.e1. doi: 10.1016/j.jhsa.2011.10.041. Epub 2011 Dec 20.
Intramedullary fixation is one treatment option for distal radius fractures. Our purpose was to compare the outcomes of intramedullary nailing to those of casting for these injuries.
From 2006 to 2009, we reviewed 63 adult patients with isolated distal radius fractures. Thirty-one patients had surgical fixation with an intramedullary device (IMN group) within 4 weeks of the injury, and 32 (cast group) had casting as definitive treatment of the fracture. Clinical outcomes (grip strength; Disabilities of the Arm, Shoulder, and Hand scores; active wrist range of motion; and complications) and radiographic indices (radial inclination, radial height, ulnar variance, and tilt) of both groups were analyzed for the 1-, 2-, 4-, 6-, and 12-month follow-up periods.
The flexion-extension arc was significantly higher in the IMN group than in the cast group at 2-, 6-, and 12-month follow-up. The IMN group exhibited significantly greater grip strength and lower DASH scores throughout the follow-up period. At final follow-up, all radiographic indices were significantly better in the IMN group than in the cast group. There was no significant difference between the initial reduction to final position in the IMN group, but the cast group showed an increase in ulnar variance and a significant change in dorsal-volar tilt. In addition, the cast group experienced more clinical complications in the delayed period compared to the IMN group.
Intramedullary nail fixation, as compared to casting, results in less functional disability, not only in the early postoperative period but also up to a year after treatment. On the basis of our data, intramedullary fixation should be considered for patients with unstable extra-articular or simple intra-articular distal radius fractures.
髓内固定是桡骨远端骨折的一种治疗选择。我们的目的是比较髓内钉固定与石膏固定治疗这些损伤的效果。
2006年至2009年，我们回顾了63例孤立性桡骨远端骨折的成年患者。31例患者在受伤后4周内接受了髓内装置手术固定（髓内钉组），32例（石膏组）接受石膏固定作为骨折的确定性治疗。分析了两组在1个月、2个月、4个月、6个月和12个月随访期的临床结果（握力；手臂、肩部和手部功能障碍评分；腕关节主动活动范围；以及并发症）和影像学指标（桡骨倾斜度、桡骨高度、尺骨变异和倾斜）。
在2个月、6个月和12个月随访时，髓内钉组的屈伸弧明显高于石膏组。在整个随访期内，髓内钉组的握力明显更大，DASH评分更低。在最终随访时，髓内钉组的所有影像学指标均明显优于石膏组。髓内钉组从初始复位到最终位置没有显著差异，但石膏组尺骨变异增加，掌背倾斜有显著变化。此外，与髓内钉组相比，石膏组在延迟期出现更多临床并发症。
与石膏固定相比，髓内钉固定不仅在术后早期，而且在治疗后长达一年的时间里，导致的功能残疾更少。根据我们的数据，对于不稳定的关节外或简单关节内桡骨远端骨折患者，应考虑采用髓内固定。
