Babikir Elhadi Musaab Elhadi, Al-Maqdassy Eyad Daood, Hasan Khalid, Abdul Hameed Shamsi, Alhammoud Abduljabbar, Al-Dosari Mohammed Mubarak Al-Ateeq
Department of Orthopedic Surgery, Hamad General Hospital, Doha, P.O box: 3050, Qatar.
Department of Orthopaedics, Hamad General Hospital, Doha, Qatar.
Int Orthop. 2017 Sep;41(9):1763-1769. doi: 10.1007/s00264-017-3516-0. Epub 2017 Jun 27.
The purpose of this study was to assess the clinical, radiologic and functional outcome of treating comminuted intra-articular distal radius fractures with fragment specific fixation.
This was a retrospective chart review of 25 unstable intra-articular distal radius fractures (type C2 AO) that had fragment specific fixation done in the orthopaedic department of the Hamad General Hospital (level 1 trauma center) over three years (2010-2013), with a follow up of one year post-operatively. Pre-operative X-rays (wrist parameters) were compared to post-operative X-rays at different time points (i.e. 6 weeks, 3 months, 6 months, etc.). Range of motion and grip strength were recorded at different time points until the final follow up evaluation. All the data has been obtained from patients' charts (including outpatient and occupational therapy rehabilitation range of motion data) after final approval from the Hamad Corporation medical research center/Ethics committee.
There were 25 patients ranging in age from 24 to 58 years with 13 patients above 35 years (52%) and 12 patients below 35 years (48%). There were 22 males (88%) and 3 females (12%) with different mechanisms of injury such as falling from height (average 2 metres), which was the most common with 13 patients (52%), and most were work related. Left wrist was more common than right wrist injuries and mostly in the non-dominant hand with 14 patients (56%). There was an obvious improvement between pre and post-operative wrist parameters at different time points, but P-values were not significant; supination and pronation at six weeks of follow up showed significant values (p = 0.04 & 0.03, respectively). Grip strength improved about 76% compared to the normal side.
Fragment specific fixation is a reasonable alternative for treating intra-articular distal radius fractures. At final follow up evaluations, results showed a better clinical, radiological and functional outcome. Stable fixation allowed starting active and passive motion of the wrist without compromising post-operative alignment.
本研究旨在评估采用碎骨块特异性固定治疗桡骨远端关节内粉碎性骨折的临床、影像学及功能结果。
这是一项回顾性病历审查研究，对哈马德总医院（一级创伤中心）骨科在三年（2010 - 2013年）期间采用碎骨块特异性固定治疗的25例不稳定桡骨远端关节内骨折（C2型AO骨折）进行研究，并在术后随访一年。将术前X线片（腕部参数）与不同时间点（即6周、3个月、6个月等）的术后X线片进行比较。在不同时间点记录活动范围和握力，直至最终随访评估。所有数据均在获得哈马德公司医学研究中心/伦理委员会最终批准后，从患者病历中获取（包括门诊及职业治疗康复活动范围数据）。
25例患者年龄在24至58岁之间，其中13例患者年龄在35岁以上（52%），12例患者年龄在35岁以下（48%）。男性22例（88%），女性3例（12%），损伤机制各异，如从高处跌落（平均2米），这是最常见的损伤机制，有13例患者（52%），且大多数与工作相关。左手腕损伤比右手腕更常见，且大多发生在非优势手，有14例患者（56%）。不同时间点的术前和术后腕部参数有明显改善，但P值无统计学意义；随访6周时旋前和旋后显示有统计学意义的值（分别为p = 0.04和0.03）。与健侧相比，握力提高了约76%。
碎骨块特异性固定是治疗桡骨远端关节内骨折的一种合理选择。在最终随访评估中，结果显示临床、影像学及功能结果较好。稳定的固定允许在不影响术后对线的情况下开始腕关节的主动和被动活动。
