Fontès D
Clinique du sport, 36, boulevard Saint-Marcel, 75005 Paris, France.
Hand Surg Rehabil. 2016 Dec;35S:S60-S68. doi: 10.1016/j.hansur.2016.01.009. Epub 2016 Oct 21.
Distal radius fracture is actually quite rarely isolated and triangular fibrocartilaginous complex (TFCC) is often involved with the same mechanism of injury. A contemporary management of the treatment of the initial fracture is ideal and so benefits from a routine arthroscopic management. Nevertheless, in the absence of diagnosis and therefore early treatment, the symptoms may be located at the ulnar crossroads and justify specific treatment of TFCC. It is generally conducted after an accurate arthroscopic lesion classification guiding a procedure, depending on the lesion vascularization as well as its possible destabilization potential (debridement, capsular suture or foveal reattachment). Unfortunately, too often the radius fracture is insufficiently stabilized by an inadequate fixation process or inappropriate orthopedic management with a positive ulnar variance consequence and an ulnar plus syndrome. A "wafer procedure" may then sometimes be proposed if a shortening of less than 3mm is needed and that the distal radio-ulnar joint is not too disorganized.
桡骨远端骨折实际上很少单独发生,三角纤维软骨复合体(TFCC)常因相同的损伤机制而受累。对初始骨折进行当代治疗是理想的,因此常规关节镜治疗有益。然而,在缺乏诊断及早期治疗的情况下,症状可能出现在尺侧交叉处,这就需要对TFCC进行特殊治疗。一般在准确的关节镜下病变分类指导下进行治疗,具体治疗方法取决于病变的血管化情况及其可能的不稳定潜能(清创、关节囊缝合或中央凹重新附着)。不幸的是,由于固定过程不足或骨科处理不当,导致桡骨骨折固定不充分,出现正尺骨变异及尺骨阳性综合征的情况屡见不鲜。如果需要缩短小于3毫米且桡尺远侧关节不太紊乱,有时可能会建议采用“骨片切除术”。