Sato Kotaro, Murakami Kenya, Mimata Yoshikuni, Numata Norio, Shiraishi Hideo, Doita Minoru
Department of Orthopaedic Surgery, Iwate Medical University, 19-1, Uchimaru, 0208505 Morioka Iwate, Japan.
Department of Orthopaedic Surgery, Iwate Medical University, 19-1, Uchimaru, 0208505 Morioka Iwate, Japan.
Orthop Traumatol Surg Res. 2018 Nov;104(7):1101-1105. doi: 10.1016/j.otsr.2018.07.020. Epub 2018 Sep 20.
Although volar locking plates (VLPs) have been exclusively used for unstable distal radius fractures (DRFs), the optimal management of distal ulna fractures (DUFs) remains controversial. Internal fixation using a plate for DUFs might be challenging because of the presence of osteoporotic bone and fragile bone fragments in elderly patients.
We hypothesized that a strategy including VLP fixation for DRFs and non-intervention for DUFs with early wrist mobilization would provide encouraging results in elderly patients.
Eighteen patients (17 women and one man, mean age 74.7 years) were included in the study. According to the Biyani classification, there were seven patients with type-1, three with type-2, five with type-3, and three with type-4 DUFs. Radiological results were analyzed in 18 patients and the clinical results could be evaluated in 10 patients who attended the necessary follow-up meetings. Ulnar angular deformity (UAD) and ulnar shortening amount (USA) were measured using anteroposterior radiographs. USA was defined as the difference in ulnar variance between just after surgery and at the final visit. Clinical results were assessed using the modified Gartland and Werley score, disability arm shoulder hand (DASH) score, range of motion, grip strength, pain, and distal radioulnar joint (DRUJ) instability.
All ulna metaphyseal fractures united. The mean UAD just after surgery was 5.9° (range, 0-22). At the final visit, the mean UAD was 6.4° (range, 0-17). The mean USA was 0.35mm, and only one patient showed ulnar shortening of >2mm. The results were "excellent" in nine patients and "good" in one, according to the modified Gartland and Werley score. The mean DASH score was 4.2. Mean flexion and extension angles were 58° and 71°. One patient complained of ulnar-sided pain during exertion and no patients complained of DRUJ instability.
All DUFs achieved good radiological results, including comminuted fractures. Functional outcomes were promising, including wide wrist ROM and no DRUJ instability. An approach including VLP fixation for DRFs and non-intervention for DUFs is a good option for elderly patients.
IV retrospective study.
尽管掌侧锁定钢板（VLP）一直专门用于治疗不稳定的桡骨远端骨折（DRF），但尺骨远端骨折（DUF）的最佳治疗方法仍存在争议。由于老年患者存在骨质疏松性骨和易碎的骨碎片，使用钢板对DUF进行内固定可能具有挑战性。
我们假设一种包括对DRF采用VLP固定以及对DUF不进行干预并早期进行腕关节活动的策略，会在老年患者中取得令人鼓舞的结果。
本研究纳入了18例患者（17例女性和1例男性，平均年龄74.7岁）。根据Biyani分类，有7例1型、3例2型、5例3型和3例4型DUF患者。对18例患者的放射学结果进行了分析，对10例参加了必要随访的患者的临床结果进行了评估。使用前后位X线片测量尺骨角畸形（UAD）和尺骨缩短量（USA）。USA定义为术后即刻与末次随访时尺骨长度差异。使用改良的Gartland和Werley评分、上肢残疾肩手（DASH）评分、活动范围、握力、疼痛以及桡尺远侧关节（DRUJ）不稳来评估临床结果。
所有尺骨干骺端骨折均愈合。术后即刻平均UAD为5.9°（范围0 - 22°）。末次随访时，平均UAD为6.4°（范围0 - 17°）。平均USA为0.35mm，只有1例患者尺骨缩短>2mm。根据改良的Gartland和Werley评分，9例患者结果为“优”，1例为“良”。平均DASH评分为4.2。平均屈伸角度分别为58°和71°。1例患者在用力时诉尺侧疼痛，无患者诉DRUJ不稳。
所有DUF均取得了良好的放射学结果，包括粉碎性骨折。功能结果令人满意，包括广泛的腕关节活动度且无DRUJ不稳。一种包括对DRF采用VLP固定以及对DUF不进行干预的方法对于老年患者是一个不错的选择。
IV级回顾性研究。
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