Weil Yoram A, Mosheiff Rami, Firman Shimon, Liebergall Meir, Khoury Amal
Department of Orthopaedics, Hadassah Hebrew University Medical Centre, Jerusalem, Israel.
Department of Orthopaedics, Hadassah Hebrew University Medical Centre, Jerusalem, Israel.
Injury. 2014 Jun;45(6):960-4. doi: 10.1016/j.injury.2014.02.011. Epub 2014 Feb 15.
Operative fixation of distal radius fractures using fixed-angle devices has become increasingly common. Although good to excellent results have been reported in acute fractures, little is currently known regarding the fixation of healing displaced distal radius fractures that were presented late. The aim of this study was to evaluate the results of internal fixation of distal radius fractures presented late (>21 days) as compared with an acute-care control group.
Forty patients operated on for displaced distal radius fractures, presenting more than 21 days after injury (delayed treatment (DT) group), were compared with 75 age-matched controls with acute fracture repair (≤21 days). The same surgical approach was used in both groups, together with dorsal soft-tissue and brachioradialis release. No osteotomy was required. Direct and indirect reduction aids were used. A fixed-angle device (DVR; Biomet Inc., Warsaw, IN, USA) was used in both groups. Mean follow-up was 3.4 years. Quick DASH (Disabilities of the Arm, Shoulder and Hand) and Short Form 12 scores were used to evaluate outcome, as well as radiographic analysis for Arbeitsgemeinschaft für Osteosynthesefragen(AO)/Orthopaedic Trauma Association(OTA) classification, volar tilt, radial inclination and radial length.
Average age was 53 years in both groups and male to female (M/F) ratio was similar in the study groups. Mean time to surgery was 30 days in the DT group and 8 days in the control group. There were significantly more type C (91.5% vs. 67.5%) fractures in the control group. The average quick DASH score was 27.1 in the DT group as compared with 6.3 in the control group (p<0.03); however, when controlling for two outlier cases with complications (hardware irritation and a sensory neuropathy) there was no significant difference. Volar tilt, radial inclination and length were similar in both groups and were within normal anatomical values.
Delayed primary operative fixation of displaced unstable distal radial fractures is a viable option for cases that were presented late, with predictable, favourable results. Neither extensile approaches nor formal osteotomies are required.
使用角度固定装置对桡骨远端骨折进行手术固定已越来越普遍。尽管急性骨折的治疗效果已报道良好至极佳，但目前对于延迟就诊的移位桡骨远端愈合骨折的固定情况知之甚少。本研究的目的是评估延迟就诊（>21天）的桡骨远端骨折内固定结果，并与急性治疗对照组进行比较。
40例桡骨远端移位骨折患者在受伤21天以上接受手术治疗（延迟治疗组），与75例年龄匹配的急性骨折修复患者（≤21天）进行对照。两组采用相同的手术入路，同时进行背侧软组织和肱桡肌松解。无需截骨。使用直接和间接复位辅助工具。两组均使用角度固定装置（DVR；美国印第安纳州华沙市的Biomet公司）。平均随访3.4年。采用快速上肢、肩部和手部功能障碍（Quick DASH）评分和简明健康调查问卷12项（Short Form 12）评分评估结果，并通过影像学分析评估骨折的AO/骨科创伤协会（OTA）分类、掌倾角、桡偏角和桡骨长度。
两组平均年龄均为53岁，研究组男女比例相似。延迟治疗组平均手术时间为30天，对照组为8天。对照组C型骨折明显更多（91.5%对67.5%）。延迟治疗组平均Quick DASH评分为27.1，对照组为6.3（p<0.03）；然而，在排除两例有并发症（内植物刺激和感觉神经病变）的异常病例后，两组无显著差异。两组的掌倾角、桡偏角和长度相似，均在正常解剖值范围内。
对于延迟就诊的移位不稳定桡骨远端骨折，延迟一期手术固定是一种可行的选择，结果可预测且良好。无需广泛的手术入路或正式的截骨术。
