Obert L, Uhring J, Rey P B, Rochet S, Lepage D, Leclerc G, Serre A, Garbuio P
Service d'orthopédie, de traumatologie, de chirurgie plastique, reconstructrice et assistance main, CHU Jean Minjoz, boulevard Fleming, université de Franche-Comté 25030 Besançon, France.
Chir Main. 2012 Dec;31(6):287-97. doi: 10.1016/j.main.2012.08.010. Epub 2012 Oct 27.
Distal radius fractures remain the most frequent fractures in the adult. Associated osteoporosis increases morbidity risk (secondary displacement is the most frequent) and mortality risk (in women older than 60). Severity of the fracture and functional results are related to the bone mineral density. Anatomy has been recently revisited with better description of palmar and dorsal aspects in order to avoid material-related complications. Standard postero-anterior, lateral and oblique radiographs of the wrist show the fracture and the displacement. CT scan is warranted if conventional X-rays are insufficient to show the articular surface. The involvement of the metaphysis (comminution), the epiphysis (articular fracture) and the ulna is different in each case and each fracture is an association of these three components. The MEU classification describes the fracture with sufficient inter-observer reliability and intra-observer reproducibility to be a useful tool for treatment and prognosis. The PAF system is used to propose the most appropriate treatment for each patient. Anatomical reduction and stable fixation are associated with good functional results but in high demanding patients.
桡骨远端骨折仍然是成年人中最常见的骨折。相关的骨质疏松会增加发病风险(继发移位最为常见)和死亡风险(在60岁以上的女性中)。骨折的严重程度和功能结果与骨密度有关。最近对解剖结构进行了重新审视,对掌侧和背侧方面有了更好的描述,以避免与材料相关的并发症。腕部标准的正位、侧位和斜位X线片可显示骨折及移位情况。如果传统X线片不足以显示关节面,则需要进行CT扫描。干骺端(粉碎)、骨骺(关节骨折)和尺骨的受累情况在每种情况下都有所不同,每个骨折都是这三个组成部分的组合。MEU分类描述骨折时具有足够的观察者间可靠性和观察者内可重复性,是治疗和预后的有用工具。PAF系统用于为每位患者提出最合适的治疗方案。解剖复位和稳定固定与良好的功能结果相关,但适用于要求较高的患者。