Uzel A-P, Bulla A, Tchéro H, Tsiaviry P, Bourges C, Daculsi G
Service d'orthopédie et de traumatologie, CHU de Pointe-À-Pitre, route de Chauvel, 97159 Pointe-à-Pitre cedex, Guadeloupe.
Chir Main. 2013 Feb;32(1):37-43. doi: 10.1016/j.main.2012.12.003. Epub 2013 Jan 7.
Intra-articular distal radial fractures in young subjects occur in severe trauma. Articular reduction needs to be anatomical. We report four cases with the particularity of having a 90° or 180° rotated lunate fossa. Our goal is to bring out the positive aspects of surgical procedure by volar medial approach and to assess long-term functionnal and radiological results.
Our study focused on four men whose average age was 27 (age range from 19 to 43). The fractures were type IV according to Melone's classification. The associated lesions included: one fracture of the base of the ulnar styloid, one fracture of the distal quarter of the ulnar diaphysis and one scapho-lunate diastasis. We used a volar medial approach between the flexors tendons and the ulnar bundle in order to pin the fragment of lunate fossa. The rest of the radial epiphysis was pinned after a 5mm skin incision. In two cases, this pinning was complemented with a brachial-antebrachial-palmar cast and in the other two cases with an external fixator.
The follow-up period averaged 68.8 (18 to 115) months, all the patients were clinically examined through antero-posterior, lateral and dynamic X-rays. The objective results assessed according to Green and O'Brien's criteria, later modified by Cooney, were as follows: two very good, one good, one average. The X-rays showed consolidated fractures. According to Knirk and Jupiter's classification of arthritis, we had three grades 0, one of which showed a subchondral sclerosis of the lunate fossa, and one grade 3.
Imaging with simple radiographs is not sufficient and needs to be complemented with CT scan. Our approach allows for direct access to the fragment of the lunate fossa and easier visualization of the distal radioulnar, compared to Henry's approach, thereby avoiding excessive traction of the median nerve. TYPE D'ÉTUDE: Niveau IV.
年轻患者的桡骨远端关节内骨折多由严重创伤引起。关节面复位需达到解剖复位。我们报告4例具有90°或180°旋转月骨窝的特殊病例。我们的目的是阐述掌侧内侧入路手术的积极方面，并评估长期功能和影像学结果。
我们的研究聚焦于4名男性，平均年龄27岁（年龄范围19至43岁）。根据梅隆分类法，骨折均为IV型。相关损伤包括：1例尺骨茎突基底骨折、1例尺骨干远端四分之一骨折和1例舟月关节分离。我们在屈肌腱和尺侧束之间采用掌侧内侧入路，以固定月骨窝碎片。桡骨骨骺的其余部分在做5mm皮肤切口后进行固定。2例采用肱-前臂-掌侧石膏固定，另外2例采用外固定架固定。
随访期平均68.8个月（18至115个月），所有患者均通过正位、侧位和动态X线进行临床检查。根据格林和奥布赖恩标准评估的客观结果，后经库尼修改，结果如下：2例非常好，1例好，1例一般。X线显示骨折愈合。根据克尼克和朱庇特的关节炎分类，我们有3例0级，其中1例月骨窝有软骨下硬化，1例3级。
单纯X线片成像不足，需要CT扫描补充。与亨利入路相比，我们的入路可直接显露月骨窝碎片，更便于观察桡尺远侧关节，从而避免正中神经过度牵拉。研究类型：IV级。
