Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway.
Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
J Orthop Surg Res. 2023 Mar 27;18(1):247. doi: 10.1186/s13018-023-03733-5.
Recent guidelines recommend non-operative treatment as primary treatment in elderly patients with displaced distal radius fractures. Most of these fractures are closely reduced. We aimed to evaluate the radiological results of closed reduction and casting of dorsally displaced distal radius fractures in patients 65 years or older.
A total of 290 patients treated during the years 2015, 2018 and 2019 in an urban outpatient fracture clinic with complete follow-up at least 5 weeks post-reduction were available for analysis. Closed fracture reduction was performed by manual traction under hematoma block. A circular plaster of Paris cast was used. Radiographs pre- and post-reduction and at final follow-up were analyzed.
Mean age was 77 years (SD 8) and 258 (89%) were women. Dorsal tilt improved from mean 111° (range 83-139) to 89° (71-116) post-reduction and fell back to mean 98° (range 64-131) at final follow-up. Ulnar variance was 2 mm ((-1)-12) pre-reduction, 0 mm ((-3)-5) post-reduction and ended at mean 2 mm (0-8). Radial inclination went from 17° ((-6)-30) to 23° (SD 7-33), and then back to 18° (0-32) at final follow-up. 41 (14%) patients had worse alignment at final follow-up compared to pre-reduction. 48 (17%) obtained a position similar to the starting point, while 201 (69%) improved. Fractures with the volar cortex aligned after reduction retained 0.4 mm (95% Confidence Interval (CI) 0.1 to 0.7; p = 0,022) more radius length during immobilization. In a regression analysis, less ulnar variance in initial radiographs (OR 1.8 (95% CI 1.4 to 2.3) per mm, p < 0.001) and lower age (OR 1.06 (95% CI 1.02 to 1.09) per year, p < 0.003) protected against loss of reduction.
Subsequent loss of reduction after initial closed reduction was seen in most distal radius fractures. Reduction improved overall alignment in 2/3 of the patients at final follow-up. An aligned volar cortex seemed to protect partially against loss of radial length.
最近的指南建议将手术治疗作为老年移位性桡骨远端骨折患者的主要治疗方法。这些骨折大多数都是紧密复位的。我们旨在评估 65 岁及以上患者背侧桡骨远端骨折闭合复位和石膏固定的影像学结果。
2015 年、2018 年和 2019 年在城市门诊骨折诊所接受治疗的 290 例患者均接受了完整的随访，至少在复位后 5 周进行随访。通过血肿块下的手动牵引进行闭合骨折复位。使用圆形石膏绷带。分析复位前、复位后和最终随访时的 X 光片。
平均年龄为 77 岁（标准差 8 岁），258 例（89%）为女性。背侧倾斜从复位前的平均 111°（83-139）改善至复位后的 89°（71-116），最终随访时恢复至平均 98°（64-131）。尺侧偏移在复位前为 2 毫米（-1-12），复位后为 0 毫米（-3-5），最终平均为 2 毫米（0-8）。桡骨倾斜从 17°（-6-30）变为 23°（标准差 7-33），最终随访时恢复至 18°（0-32）。41 例（14%）患者最终随访时的对线情况较复位前更差。48 例（17%）患者恢复到与初始位置相似的位置，而 201 例（69%）患者得到改善。复位后掌侧皮质对线的骨折在固定期间保留了 0.4 毫米（95%置信区间（CI）0.1 至 0.7；p=0.022）更多的桡骨长度。在回归分析中，初始 X 光片上的尺侧偏移较小（每毫米 1.8（95%CI 1.4 至 2.3），p<0.001）和年龄较低（每年 1.06（95%CI 1.02 至 1.09），p<0.003）可防止复位丢失。
在初始闭合复位后，大多数桡骨远端骨折均出现复位后丢失。在最终随访时，2/3 的患者的整体对线得到改善。掌侧皮质对线似乎部分防止了桡骨长度的丢失。
