Asawatreratanakul Pasin, Fongsri Warangkana, Suwanno Porames, Suwannaphisit Sitthiphong
Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, 15 Karnjanavanich Road, Hat Yai, Songkhla, 90112, Thailand.
Ann Med Surg (Lond). 2021 Oct 16;71:102966. doi: 10.1016/j.amsu.2021.102966. eCollection 2021 Nov.
There are many choices of surgical treatment for a distal radius fracture. The goal of treatment in these injuries is stable anatomical reduction of the articular surface. In a coronal split fracture, the dorsal fragment tends to dorsal displacement during drilling or when applying the distal locking screws of the plate.
We present an illustrative case from a larger series of a 65-year-old Thai woman with an intraarticular distal radius fracture with a dorsal fragment from a coronal-split configuration reduced and stabilized with a volar locking plate utilizing a large point reduction clamp held in place with a rubber stopper from a sterile glass bottle to counter the displacement effect of the drilling.
Using a large point reduction clamp with a rubber stopper from a sterile glass bottle enables this type of difficult fracture to be both reduced and stabilized with the locking screw easily inserted to stabilize the dorsal fragment without any further displacement. The rubber stopper acts to distribute the compressive force from the large point reduction clamp over a larger area allowing a more stable fracture stabilization, while at the same time reducing skin and soft tissue trauma at the dorsal aspect of the wrist.
This workaround allows improved stability in reduction and stabilization of a coronal split intraarticular distal radius fracture. The advantage of this workaround is that it uses small things readily available in every operating room setting, and it does not require any special experience or skills.
桡骨远端骨折有多种手术治疗选择。这些损伤的治疗目标是实现关节面的稳定解剖复位。在冠状面劈裂骨折中,在钻孔或应用钢板远端锁定螺钉时,背侧骨折块往往会向背侧移位。
我们展示一个来自大量病例系列中的典型病例,一名65岁泰国女性,患有关节内桡骨远端骨折,冠状面劈裂导致背侧骨折块,使用掌侧锁定钢板进行复位和固定,利用一个来自无菌玻璃瓶的橡胶塞固定的大复位钳来抵消钻孔的移位作用。
使用来自无菌玻璃瓶的带有橡胶塞的大复位钳,能够使这种类型的复杂骨折得以复位和固定,同时能轻松插入锁定螺钉以稳定背侧骨折块而不会发生进一步移位。橡胶塞起到将大复位钳的压缩力分散到更大面积的作用,从而实现更稳定的骨折固定,同时减少手腕背侧的皮肤和软组织创伤。
这种变通方法可提高冠状面劈裂关节内桡骨远端骨折复位和固定的稳定性。这种变通方法的优点是它使用了手术室中随时可得的小物件,并且不需要任何特殊经验或技能。