Azboy Ibrahim, Demirtaş Abdullah, Alemdar Celil, Gem Mehmet, Uzel Kadir, Arslan Huseyin
Department of Orthopaedic Research, The Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA.
Department of Orthopaedics and Traumatology, Göztepe Training and Research Hospital, Medeniyet University, Istanbul, Turkey.
Indian J Orthop. 2017 Nov-Dec;51(6):697-703. doi: 10.4103/ortho.IJOrtho_79_16.
The treatment of diaphyseal forearm fractures using open reduction and plate fixation is generally accepted as the best choice in many studies. However, periosteal stripping, haematoma evacuation may result in delayed union, nonunion and infection. Refracture after plate removal is another concern. To overcome these problems intramedullary nails (IM) with different designs have been used with various outcomes. However previous IM nails have some shortcomings such is rotational instability and interlocking difficulties. We evaluated the results of newly designed IM nail in the treatment of diaphyseal forearm fractures in adults.
32 patients who had been treated with the interlocking IM nail for forearm fractures between 2011 and 2014 were included in this study. There were 23 males and 9 females with mean age of 36 years (range 18-68 years). 22 patients (68.8%) had both bone fractures. Nine patients (28.1%) had open fractures. The remaining ten patients (31.2%) had radius or ulna fractures. Grace and Eversmann rating system was used to assess functional evaluation. Patient reported outcomes were assessed using the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire scores.
Union was achieved in all patients. The mean followup was 17 months (range 13 - 28 months). According to the Grace-Eversmann criteria, 27 patients (87.5%) had excellent or good results. The mean DASH score was 14 (range 5-36). Overall complication rate was 12.5%. Superficial infection was encountered in two patients. One patient had delayed union, however fracture healed without any additional surgical procedure. One patient who had open grade 3A, comminuted proximal third radius fracture developed radioulnar synostosis.
The new design IM interlocking forearm nail provides satisfactory functional and radiological outcomes in the treatment of adult diaphyseal forearm fractures.
在许多研究中，采用切开复位钢板固定治疗肱骨干骨折通常被认为是最佳选择。然而，骨膜剥离、血肿清除可能导致骨折延迟愈合、不愈合和感染。取出钢板后的再骨折是另一个问题。为克服这些问题，已使用了不同设计的髓内钉（IM），但结果各异。然而，以往的髓内钉存在一些缺点，如旋转不稳定和锁定困难。我们评估了新设计的髓内钉治疗成人肱骨干骨折的效果。
本研究纳入了2011年至2014年间接受前臂骨折交锁髓内钉治疗的32例患者。其中男性23例，女性9例，平均年龄36岁（范围18 - 68岁）。22例患者（68.8%）为双骨折。9例患者（28.1%）为开放性骨折。其余10例患者（31.2%）为桡骨或尺骨骨折。采用Grace和Eversmann评分系统进行功能评估。使用手臂、肩部和手部功能障碍（DASH）问卷评分评估患者报告的结果。
所有患者均实现骨折愈合。平均随访时间为17个月（范围13 - 28个月）。根据Grace-Eversmann标准，27例患者（87.5%）结果为优或良。平均DASH评分为14分（范围5 - 36分）。总体并发症发生率为12.5%。2例患者发生浅表感染。1例患者出现骨折延迟愈合，但未进行额外手术骨折即愈合。1例开放性3A级、近端三分之一桡骨粉碎性骨折患者发生了桡尺骨融合。
新设计的交锁髓内前臂钉在治疗成人肱骨干骨折方面提供了令人满意的功能和影像学结果。
