Department of Surgery, University of Saskatchewan, Saskatoon Orthopedic and Sports Medicine Centre, Saskatchewan, Canada.
Rebalance MD, British Columbia, Canada.
J Hand Surg Am. 2022 May;47(5):409-419. doi: 10.1016/j.jhsa.2022.01.016. Epub 2022 Mar 26.
To determine the magnitude, direction, temporal patterns, and frequency of reduction loss following nonsurgical, closed treatment of distal radius fractures in women 50 years and older and correlate these observations with bone mineral density and age.
We reviewed registry data on 1,148 patients 50 years and older with distal radius fractures managed by closed reduction and cast immobilization. Radial inclination (RI), ulnar variance (UV), and radial tilt (RT) were measured immediately and at 1, 2, 3, 6, 9, and 12 weeks after reduction. Magnitude, direction, frequency, and patterns of change were compared at each time point and correlated with bone mineral density T-scores and age using paired t tests in a mixed effects model.
Over 12 weeks, RI decreased by 3° ± 5°, the majority occurring in the first 2 weeks and significantly correlated with bone mineral density T-score and age. Unexpectedly, RI increased over time in 5% of patients. Ulnar variance increased by 2.3 ± 1.7 mm, the majority occurring in the first 3 weeks and correlated with age. Radial tilt changed by 7° ± 11° in those displacing dorsally and 8° ± 12° in those displacing volarly at 12 weeks, with the majority occurring in the first 3 weeks and significantly correlating with age. Ulnar variance and RT continued to change by small increments between weeks 3 and 6. Nearly 90% of our cohort experienced measurable loss of reduction and 50% changed at least 5° RI, 11° RT, and 2 mm UV.
Most distal radius fracture managed with closed reduction and casting have some loss of reduction, the majority occurring in the first 3 weeks and correlated with increased age and osteoporosis. This guides clinicians in informing patients about expected reduction loss, frequency of clinical and radiographic follow-up, and timing of discussions regarding the need for surgery.
TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic II.
确定 50 岁及以上女性接受非手术闭合治疗桡骨远端骨折后，其复位丢失的幅度、方向、时间模式和频率，并将这些观察结果与骨密度和年龄相关联。
我们回顾了 1148 名 50 岁及以上接受闭合复位和石膏固定治疗桡骨远端骨折的患者的登记数据。在复位后即刻和 1、2、3、6、9 和 12 周时，测量桡骨倾斜度（RI）、尺侧骨间距离（UV）和桡骨倾斜角（RT）。在每个时间点比较幅度、方向、频率和变化模式，并使用混合效应模型中的配对 t 检验将其与骨密度 T 评分和年龄相关联。
在 12 周内，RI 平均减少 3°±5°，大部分发生在最初的 2 周内，且与骨密度 T 评分和年龄显著相关。出乎意料的是，5%的患者 RI 随时间增加。UV 平均增加 2.3±1.7mm，大部分发生在最初的 3 周内，与年龄相关。在 12 周时，背侧移位的患者 RT 平均增加 7°±11°，掌侧移位的患者 RT 平均增加 8°±12°，大部分发生在最初的 3 周内，与年龄显著相关。在第 3 周到第 6 周之间，UV 和 RT 继续以较小的增量变化。我们的研究队列中，近 90%的患者存在可测量的复位丢失，50%的患者 RI、RT 和 UV 至少改变 5°、11°和 2mm。
大多数接受闭合复位和石膏固定治疗的桡骨远端骨折都有一定程度的复位丢失，大部分发生在最初的 3 周内，与年龄增加和骨质疏松症相关。这有助于指导临床医生向患者告知预期的复位丢失情况、临床和影像学随访的频率，以及讨论手术必要性的时间。
研究类型/证据水平：预后 II 级。
