Gadegone P, Gadegone W, Lokhande V, Jawrani N
Department of Orthopaedics, Lokmanya Tilak Municipal General Hospital and Lokmanya Tilak Municipal Medical College, Mumbai, India.
Department of Orthopaedics, Government Medical College, Chandrapur, India.
Malays Orthop J. 2021 Nov;15(3):36-44. doi: 10.5704/MOJ.2111.006.
The aim of this study was to evaluate the clinical outcomes following treatment of distal radial fractures using intramedullary elastic wires with a combination of either cast immobilisation or external fixation.
A total of 42 patients (24 females and 18 males) aged 40 to 78 years who presented with displaced and unstable, closed or grade I open, extra- and/or intra-articular fractures of the distal radius were included in the study. Twenty-seven fractures were AO/OTA Type A2-A3 and 15 Type C1-C2. Twenty-four patients were treated with antegrade intramedullary (IM) fixation with elastic wires followed by cast immobilisation and 18 required an external fixator in lieu of casting.
Final follow-up evaluation was conducted 12 months post-surgery using Sarmiento's modification of Lindstrom criteria and the demerit point system of Gartland and Werley. Successful fracture union was observed in all patients between eight to 14 weeks. Using Sarmiento's modification of Lindstrom criteria, 12 patients (28.6%) had excellent, 23 (54.8%) had good and 7 (16.6 %) had fair results. Based on the functional evaluation using the demerit point system of Gartland and Werley, 13 patients (31%) had excellent, 25 (59.5%) had good and four (9.5%) had fair results. None of the patients had a poor outcome using either of these criteria. Although a fracture union rate of 100% was confirmed clinically and radiographically, eight out of the 42 patients had minor complications in our study. One patient had uneventful IM migration of the wires, one patient reported a feeling of wire loosening, three patients complained of joint stiffness and soft tissue irritation, and three others reported on-going pain. The total cost of all implants used per case was less than INR 1,000.
Good to excellent functional and radiographic outcomes with easy to manage complications are achieved with the techniques described. Patient selection is key to determining which particular method should be prescribed in a given case.
本研究旨在评估使用髓内弹性钉结合石膏固定或外固定治疗桡骨远端骨折后的临床疗效。
本研究纳入了42例年龄在40至78岁之间的患者（24例女性和18例男性），这些患者均表现为桡骨远端移位且不稳定的闭合性骨折或I级开放性骨折，包括关节外和/或关节内骨折。其中27例骨折为AO/OTA A2 - A3型，15例为C1 - C2型。24例患者采用顺行髓内弹性钉固定，随后进行石膏固定，18例患者则需要使用外固定器代替石膏固定。
术后12个月采用Sarmiento改良的Lindstrom标准和Gartland与Werley的缺点评分系统进行最终随访评估。所有患者在8至14周内均实现了骨折顺利愈合。根据Sarmiento改良的Lindstrom标准，12例患者（28.6%）疗效为优，23例（54.8%）为良，7例（16.6%）为可。基于Gartland与Werley缺点评分系统的功能评估，13例患者（31%）疗效为优，25例（59.5%）为良，4例（9.5%）为可。使用这两种标准评估，均无患者疗效为差。尽管临床和影像学检查均证实骨折愈合率为100%，但在本研究的42例患者中，有8例出现了轻微并发症。1例患者出现弹性钉无异常的髓内移位，1例患者感觉弹性钉松动，3例患者抱怨关节僵硬和软组织刺激，另外3例患者报告持续疼痛。每例患者使用的所有植入物总费用低于1000印度卢比。
采用所述技术可实现良好至优异的功能和影像学结果，且并发症易于处理。患者选择是决定在特定病例中应采用哪种具体方法的关键。
