Consultant Orthopedic Surgeon, Semalk Hospital, Ottapalam, India.
J Am Acad Orthop Surg Glob Res Rev. 2020 Jun 1;4(6). doi: 10.5435/JAAOSGlobal-D-19-00114. eCollection 2020 Jun.
The existing method of closed reduction cannot reduce the complete intra-articular fracture of the distal radius; none of the available methods of percutaneous pinning alone can fix the intra-articular fracture of the distal radius. A prospective study including 108 complete intra-articular fractures of AO type B and C in 108 patients was conducted from 2013 to 2018. The subjects were aged between 18 and 84 years and included 61 men and 47 women. The cohort was divided into three age groups: ages 18 to 44, ages 45 to 59, and ages 60 to 84. The surgical technique includes an innovative method of closed reduction of the fracture in four steps, namely, distraction, compression, milking of the comminuted fragments, and repositioning of distal radio-ulnar joint, and a novel method of percutaneous pinning by creating two triangles in two planes by using six k-wires (1.6 mm) by encircling the metaphysis without interfering with the radio-carpal joint. Metaphyseal collapse is prevented by the role of k-wires such as the steel scaffolding in cement concreting, thereby maintaining the congruity of the radio-carpal joint and negative ulnar variance. Excellent and good results come to 87%. The patients can return to their original employment within 3 to 6 months in contrast to the other methods.
现有的闭合复位方法无法使桡骨远端完全关节内骨折复位;单独使用经皮克氏针固定的方法无法固定桡骨远端关节内骨折。一项前瞻性研究纳入了 2013 年至 2018 年间 108 例 AO 分型 B 和 C 的 108 例完全关节内骨折患者,这些患者年龄在 18 至 84 岁之间,包括 61 名男性和 47 名女性。该队列分为三个年龄组:18 至 44 岁、45 至 59 岁和 60 至 84 岁。手术技术包括一种创新的闭合复位骨折的四步方法,即牵引、压缩、粉碎碎片的抽吸和重新定位远侧桡尺关节,以及一种通过使用 6 根(1.6 毫米)克氏针在两个平面上创建两个三角形的新型经皮克氏针固定方法,这些克氏针环绕干骺端而不干扰桡腕关节。通过克氏针(如水泥混凝土中的钢支架)的作用防止干骺端塌陷,从而保持桡腕关节的一致性和负性尺侧偏斜。优良率达到 87%。与其他方法相比,患者可以在 3 至 6 个月内恢复到原来的工作岗位。