Department of Orthopedic Surgery, Division of Hand and Upper Extremity, Massachusetts General Hospital, Boston, MA; and.
Department of Orthopedic Surgery British Hospital Montevideo, Uruguay.
J Orthop Trauma. 2022 May 1;36(5):e174-e181. doi: 10.1097/BOT.0000000000002286.
To determine the prevalence of ulnar head subluxation/dislocation in distal radius fracture and to discuss management, surgical outcomes, and relevant anatomy.
Urban tertiary care hospital.
PATIENTS/PARTICIPANTS: Two hundred seventy-one patients with displaced distal radius fractures undergoing surgical management were reviewed to determine the incidence of ulnar head subluxation or dislocation using the Mino criteria defined by Mino et al.
Postoperative computed tomography and radiographs were assessed for sigmoid notch and distal radioulnar joint (DRUJ) reduction and fracture healing. Range of motion, functional limitation, and pain were documented at final outcome.
Of the 271 cases, there were 8 cases of prereduction DRUJ subluxation/dislocation, including 2 frank dislocations and 6 subluxations (2.95%). All were treated with open reduction and internal fixation (ORIF) of the distal radius with a volar locked plate. In addition, 1 patient underwent ORIF of an associated distal ulnar shaft fracture and another, who had a grade 1 open fracture over the distal ulna, underwent open TFCC repair. The remaining 6 patients had closed reduction of the DRUJ without further stabilizing procedures. All had stable DRUJ joints following ORIF, both intra-operatively and at final follow-up. All ulnar heads were located within the DRUJ on post-op computed tomography; using the more sensitive radioulnar ratio there was residual ulnar head subluxation in 5/8 patients. Range of motion and functional outcome were excellent at an average of 133 weeks postoperatively. The DRUJ was stable at long-term follow-up in all patients.
Ulnar head subluxation/dislocation is an uncommon injury in the setting of distal radius fracture. When present, it can usually be treated effectively with operative stabilization of the distal radius fracture without further stabilizing procedures.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
确定桡骨远端骨折中尺骨头半脱位/脱位的发生率，并讨论其治疗、手术结果和相关解剖结构。
城市三级护理医院。
患者/参与者：回顾了 271 例接受手术治疗的桡骨远端移位骨折患者，以确定 Mino 等人定义的 Mino 标准下尺骨头半脱位或脱位的发生率。
术后行 CT 和 X 线检查评估月状切迹和下尺桡关节（DRUJ）复位及骨折愈合情况。最终结果记录关节活动度、功能受限和疼痛情况。
271 例患者中，术前有 8 例 DRUJ 半脱位/脱位，包括 2 例完全脱位和 6 例半脱位（2.95%）。所有患者均采用掌侧锁定钢板行桡骨远端切开复位内固定（ORIF）治疗。此外，1 例患者同时行尺骨远端干骺端骨折的 ORIF，另 1 例尺骨远端开放性 1 度骨折患者行 TFCC 切开修复。其余 6 例患者行 DRUJ 闭合复位，未行进一步稳定治疗。所有患者 ORIF 后 DRUJ 关节均稳定，术中及最终随访时均稳定。所有患者术后 CT 均显示尺骨头部位于 DRUJ 内；使用更敏感的桡尺比，8 例患者中有 5 例仍存在尺骨头部半脱位。术后平均 133 周时，关节活动度和功能结果均为优。所有患者在长期随访时 DRUJ 均稳定。
尺骨头半脱位/脱位在桡骨远端骨折中是一种不常见的损伤。发生时，通常可以通过手术稳定桡骨远端骨折来有效治疗，而无需进一步的稳定治疗。
治疗 IV 级。有关证据水平的完整描述，请参见作者说明。
