Matsuura Yusuke, Rokkaku Tomoyuki, Kuniyoshi Kazuki, Takahashi Kazuhisa, Suzuki Takane, Kanazuka Aya, Akasaka Tomoyo, Hirosawa Naoya, Iwase Maki, Yamazaki Atsuro, Orita Sumihisa, Ohtori Seiji
Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan.
Department of Bioenvironmental Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan.
J Orthop Res. 2017 Nov;35(11):2435-2441. doi: 10.1002/jor.23556. Epub 2017 Apr 7.
Orthopedic trauma surgeons often encounter Smith's fracture in patients who report that they have fallen on the palms of their hands. The aim of this study was to clarify the pathogenesis of Smith's fracture in basic clinical aspects. First, a survey was conducted for investigating the mechanism of injury and arm position at the time of injury among patients with Smith's fractures who consulted at our outpatient clinic. Second, we created three-dimensional finite element models (FEMs) to predict the influence of arm position on the type of injury resulting from a fall. These predictions were then used in ten freshly frozen cadavers to provide experimental proof of Smith's fractures resulting from the impact on the palmar side. Twenty-six patients (5 males and 21 females) with Smith's fractures were enrolled in this study. Injury resulting from a fall on the palm of the hand, the dorsum, or ulno-dorsum of the hand, and fisting handle was observed in 16 cases (61%), 3 cases (12%), and 1 case (4%), respectively. Six patients were uncertain of their arm position at the time of injury. FEM analysis showed that Smith's fractures occurred when the angle between the long axis of the forearm and the ground was 30°-45° in the sagittal plane and 75°-90° in the coronal plane. Smith's fractures occurred in 7 of 10 wrists in the experimental study, whereas no Colles' fractures were observed. This study demonstrated that Smith's fracture results from falling on the palm of the hand. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2435-2441, 2017.
骨科创伤外科医生经常在那些报告称自己手掌着地摔倒的患者中遇到史密斯骨折。本研究的目的是在基础临床方面阐明史密斯骨折的发病机制。首先，对在我们门诊就诊的史密斯骨折患者进行了一项调查，以探究受伤机制和受伤时的手臂位置。其次，我们创建了三维有限元模型（FEMs），以预测手臂位置对摔倒所致损伤类型的影响。然后将这些预测应用于十具新鲜冷冻的尸体，以提供手掌侧受撞击导致史密斯骨折的实验证据。本研究纳入了26例史密斯骨折患者（5例男性和21例女性）。手掌着地摔倒、手背或尺背着地摔倒以及握拳握持导致的损伤分别见于16例（61%）、3例（12%）和1例（4%）。6例患者不确定受伤时的手臂位置。有限元分析表明，当矢状面前臂长轴与地面夹角为30° - 45°且冠状面为75° - 90°时会发生史密斯骨折。在实验研究中，10个腕关节中有7个发生了史密斯骨折，而未观察到科雷氏骨折。本研究表明，史密斯骨折是由手掌着地摔倒所致。© 2017骨科研究协会。由威利期刊公司出版。《矫形外科学研究》35:2435 - 2441，2017年。
