Andersson J K, Lindau T, Karlsson J, Fridén J
Department of Hand Surgery, Sahlgrenska University Hospital and Sahlgrenska Academy, University of Gothenburg, Sweden
Pulvertaft Hand Centre, Kings Treatment Centre, Royal Derby Hospital, Derby, UK.
J Hand Surg Eur Vol. 2014 Jul;39(6):653-61. doi: 10.1177/1753193413518707. Epub 2014 Jan 8.
This study retrospectively evaluated the medical records and radiographs of patients younger than aged 25 that were referred for a second opinion due to ulnar-sided wrist pain and persistent distal radio-ulnar (DRU) joint instability. We identified 85 patients with a major wrist trauma before the age of 18. Median age at trauma was 14 years. Median time between trauma and diagnosis of DRUJ instability was 3 years. Sixty-seven patients (79%) had sustained a fracture at the initial trauma. The two most common skeletal injuries related to the DRUJ instability were Salter-Harris type II fractures (24%) and distal radius fractures (19%). In 19 patients (22%), the secondary DRUJ instability was caused by malunion or growth arrest. Eighteen patients (21%) had no fracture; in spite of this, they presented with subsequent symptomatic DRUJ instability. Fourteen of these 18 patients had a triangular fibrocartilage complex (TFCC) tear, confirmed by arthroscopy, open surgery, or magnetic resonance imaging. In conclusion, late DRUJ instability due to wrist fractures or isolated TFCC tears was found to be common in children and adolescents.
IV.
本研究回顾性评估了因尺侧腕部疼痛和持续性下尺桡关节（DRU）不稳定而被转诊以获取二次诊断意见的25岁以下患者的病历和X光片。我们确定了85例在18岁之前有严重腕部创伤的患者。创伤时的中位年龄为14岁。创伤与DRUJ不稳定诊断之间的中位时间为3年。67例患者（79%）在初次创伤时发生了骨折。与DRUJ不稳定相关的两种最常见骨骼损伤是Salter-Harris II型骨折（24%）和桡骨远端骨折（19%）。19例患者（22%）的继发性DRUJ不稳定是由骨不连或生长停滞引起的。18例患者（21%）没有骨折；尽管如此，他们随后出现了有症状的DRUJ不稳定。这18例患者中有14例经关节镜检查、开放手术或磁共振成像证实有三角纤维软骨复合体（TFCC）撕裂。总之，儿童和青少年中因腕部骨折或孤立的TFCC撕裂导致的迟发性DRUJ不稳定很常见。
IV。
