Umeå University, Department of Surgical and Perioperative Sciences (Orthopedics-Sundsvall), 901 87 Umeå, Sweden.
Sundsvall Hospital, Department of Research and development, Västernorrland County, 851 86 Sundsvall, Sweden.
Bone Joint J. 2014 Jul;96-B(7):978-83. doi: 10.1302/0301-620X.96B7.32728.
This paper investigates whether cortical comminution and intra-articular involvement can predict displacement in distal radius fractures by using a classification that includes volar comminution as a separate parameter. A prospective multicentre study involving non-operative treatment of distal radius fractures in 387 patients aged between 15 and 74 years (398 fractures) was conducted. The presence of cortical comminution and intra-articular involvement according to the Buttazzoni classification is described. Minimally displaced fractures were treated with immobilisation in a cast while displaced fractures underwent closed reduction with subsequent immobilisation. Radiographs were obtained after reduction, at 10 to 14 days and after union. The outcome measure was re-displacement or union. In fractures with volar comminution (Buttazzoni type 4), 96% (53 of 55) displaced. In intra-articular fractures without volar comminution (Buttazzoni 3), 72% (84 of 117) displaced. In extra-articular fractures with isolated dorsal comminution (Buttazzoni 2), 73% (106 of 145) displaced while in non-comminuted fractures (Buttazzoni 1), 16 % (13 of 81 ) displaced. A total of 32% (53 of 165) of initially minimally displaced fractures later displaced. All of the initially displaced volarly comminuted fractures re-displaced. Displacement occurred in 31% (63 of 205) of fractures that were still in good alignment after 10 to 14 days. Regression analysis showed that volar and dorsal comminution predicted later displacement, while intra-articular involvement did not predict displacement. Volar comminution was the strongest predictor of displacement.
本文研究了在包括掌侧粉碎性骨折作为单独参数的分类中，皮质粉碎和关节内受累是否可以预测桡骨远端骨折的移位。对 387 名年龄在 15 至 74 岁（398 处骨折）的非手术治疗桡骨远端骨折患者进行了前瞻性多中心研究。描述了 Buttazzoni 分类中皮质粉碎和关节内受累的存在情况。轻度移位的骨折采用石膏固定治疗，而移位的骨折则采用闭合复位后固定。复位后、第 10 至 14 天和愈合后拍摄 X 线片。结果测量是再移位或愈合。在掌侧粉碎性骨折（Buttazzoni 4 型）中，96%（53/55）发生移位。在无掌侧粉碎性骨折的关节内骨折（Buttazzoni 3 型）中，72%（84/117）发生移位。在孤立性背侧粉碎性骨折（Buttazzoni 2 型）中，73%（106/145）发生移位，而非粉碎性骨折（Buttazzoni 1 型）中，16%（13/81）发生移位。最初轻度移位的骨折中，有 32%（53/165）后来发生了移位。所有最初发生的掌侧粉碎性骨折均重新发生移位。在 10 至 14 天后仍对线良好的骨折中，有 31%（63/205）发生移位。背侧和掌侧粉碎性骨折预测了后来的移位，而关节内受累并未预测移位。掌侧粉碎性骨折是移位的最强预测因素。
