Ferree Steven, van der Vliet Quirine M J, Nawijn Femke, Bhashyam Abhiram R, Houwert Roderick M, Leenen Luke P H, Hietbrink Falco
Department of surgery, University Medical Centre Utrecht, The Netherlands.
Utrecht Traumacenter, Utrecht, The Netherlands.
Injury. 2018 Mar;49(3):630-635. doi: 10.1016/j.injury.2018.02.003. Epub 2018 Feb 5.
For several extremity fractures differences in morphology, incidence rate and functional outcome were found when polytrauma patients were compared to patients with an isolated injury. This is not proven for distal radius fractures (DRF). Therefore, this study aimed to analyse fracture morphology in relation to energy transfer in both poly- and mono-trauma patients with a DRF.
This was a retrospective cohort study. All patients aged 16 years and older with a DRF were included. Patients with an Injury Severity Score of 16 or higher were classified as polytrauma patients. Injuries were defined as high or low energy. All DRFs were classified using the AO/OTA fracture classification system.
A total of 830 patients with a DRF were included, 12% were polytrauma. The incidence rate of DRF in polytrauma patients was 3.5%. Ipsilateral upper extremity injury was found in >30% of polytrauma and high-energy monotrauma patients, compared to 5% in low-energy monotrauma patients. More type C DRF were found in polytrauma and high-energy monotrauma patients versus low-energy monotrauma patients. Operative intervention rates for all types of DRF were similar for polytrauma and high-energy monotrauma patients. Non-union rates were higher in polytrauma patients.
Higher energy mechanisms of injury, in polytrauma and high-energy monotrauma patients, were associated with more severe complex articular distal radius fractures and more ipsilateral upper extremity injuries. Polytrauma and high-energy monotrauma patient have a similar fracture morphology. However, polytrauma patients have in addition to more injured body regions also more non-union related interventions than high-energy monotrauma patients.
在比较多发伤患者与单纯损伤患者时，发现几种四肢骨折在形态、发病率和功能结局方面存在差异。但对于桡骨远端骨折（DRF），这一点尚未得到证实。因此，本研究旨在分析多发伤和单发伤的DRF患者骨折形态与能量传递之间的关系。
这是一项回顾性队列研究。纳入所有年龄在16岁及以上的DRF患者。损伤严重程度评分16分及以上的患者被分类为多发伤患者。损伤被定义为高能量或低能量。所有DRF均使用AO/OTA骨折分类系统进行分类。
共纳入830例DRF患者，其中12%为多发伤患者。多发伤患者中DRF的发病率为3.5%。超过30%的多发伤和高能量单发伤患者存在同侧上肢损伤，而低能量单发伤患者中这一比例为5%。与低能量单发伤患者相比，多发伤和高能量单发伤患者中C型DRF更多。多发伤和高能量单发伤患者所有类型DRF的手术干预率相似。多发伤患者的骨不连发生率更高。
多发伤和高能量单发伤患者中，较高能量的损伤机制与更严重的复杂关节面桡骨远端骨折及更多同侧上肢损伤相关。多发伤和高能量单发伤患者具有相似的骨折形态。然而，多发伤患者除了身体受伤部位更多外，与骨不连相关的干预也比高能量单发伤患者更多。
