Wakasugi Takuma, Shirasaka Ritsuro, Kawauchi Toshiyuki, Fujita Koji, Okawa Atsushi
* Department of Orthopedic Surgery, Tsuchiura Kyodo Hospital, Ibaraki, Japan.
† Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan.
J Hand Surg Asian Pac Vol. 2018 Mar;23(1):71-75. doi: 10.1142/S2424835518500091.
Intramedullary fixation for distal radius fractures is reported to be free of hardware irritation and less invasive than other fixation methods. Some specific complications associated with intramedullary fixation, such as radial nerve sensory neuritis, have been reported, but no study has focused on the complication rates of intramedullary fixation for distal radius fractures in the elderly population. Furthermore, no studies have analyzed common complications, such as carpal tunnel syndrome and flexor tenosynovitis including trigger finger, among patients with distal radius fractures treated by intramedullary fixation based on a comprehensive complication checklist.
We reviewed the medical records of 52 elderly patients with distal radius fractures treated with intramedullary nail fixation. We investigated the postoperative complications in these patients using McKay's complication checklist.
5 patients experienced radial nerve sensory disorder, and one patients developed carpal tunnel syndrome. All neurological symptoms resolved spontaneously, and these neurological complications were categorized as mild. Further, 3 patients developed trigger finger at the A1 pulley and needed triamcinolone injections for symptomatic relief. There were no tendinous complications around the implanted hardware. All tendinous complications were categorized as moderate complications and resolved with steroid injection therapy. Among skeletal complications, 1 case of postoperative volar displacement resolved with good functional outcome without the need for corrective osteotomy. This was considered a mild complication. The total complication rate was 19.2%. All complications were categorized as mild or moderate, and no patients experienced severe complications that needed further surgery such as hardware removal.
Intramedullary fixation for distal radius fractures was free from tendinous complications such as tenosynovitis and tendon ruptures around the implant, which are frequently caused by volar locking plate fixation. However, this less invasive technique could not avoid common complications such as trigger finger and carpal tunnel syndrome associated with distal radius fractures.
据报道，桡骨远端骨折的髓内固定无内植物刺激，且比其他固定方法侵入性更小。虽然已经报道了一些与髓内固定相关的特定并发症，如桡神经感觉神经炎，但尚无研究关注老年人群桡骨远端骨折髓内固定的并发症发生率。此外，尚无研究基于综合并发症清单分析髓内固定治疗桡骨远端骨折患者的常见并发症，如腕管综合征和屈肌腱腱鞘炎（包括扳机指）。
我们回顾了52例接受髓内钉固定治疗的老年桡骨远端骨折患者的病历。我们使用麦凯并发症清单调查了这些患者的术后并发症。
5例患者出现桡神经感觉障碍，1例患者发生腕管综合征。所有神经症状均自发缓解，这些神经并发症被归类为轻度。此外，3例患者在A1滑车处出现扳机指，需要注射曲安奈德以缓解症状。植入物周围没有肌腱并发症。所有肌腱并发症均被归类为中度并发症，并通过类固醇注射治疗得到解决。在骨骼并发症中，1例术后掌侧移位通过良好的功能结果得到解决，无需进行矫正截骨术。这被认为是轻度并发症。总并发症发生率为19.2%。所有并发症均被归类为轻度或中度，没有患者经历需要进一步手术（如取出内植物）的严重并发症。
桡骨远端骨折的髓内固定没有肌腱并发症，如腱鞘炎和植入物周围的肌腱断裂，而这些并发症经常由掌侧锁定钢板固定引起。然而，这种侵入性较小的技术无法避免与桡骨远端骨折相关的常见并发症，如扳机指和腕管综合征。
