Altissimi M, Antenucci R, Fiacca C, Mancini G B
Clin Orthop Relat Res. 1986 May(206):202-10.
The long-term results of the conservative treatment of wrist fractures were observed in a follow-up study of 297 cases over a period of one and one-half years to six years. The evaluation of the results was based on clinical parameters, both subjective and objective, as well as radiological features. The results were: excellent in 38% of cases, good in 49%, fair in 11.5%, and poor in 1.5%; considerably worse were the subjective results (20% fair to poor). No statistically significant relation could be found between results and type of fracture. Clinical deformities and pain in the area of the distal radioulnar joint were frequent. Decrease in grip strength was observed in 17.8% of cases. A limitation of wrist movement was not frequent. Numerous compressive neuropathies were found (41 in 35 patients), especially of the median nerve. The values relative to the three radiographic parameters under investigation (that is, radial deviation, volar tilt, and radioulnar index) were often found to be out of the normal range. The comparative study of postreduction and follow-up radiograms show the loss of reduction to be frequent, especially as far as the volar tilt is concerned. The frequent radiologic deformities are associated with significantly bad results only in cases of extremely abnormal values. However, fractures of the distal radius are not to be underestimated. Long-term results following conservative treatment may not be as acceptable as is generally assumed.
在一项对297例腕部骨折患者进行的为期一年半至六年的随访研究中，观察了保守治疗的长期效果。结果评估基于主观和客观的临床参数以及放射学特征。结果如下：38%的病例为优，49%为良，11.5%为中，1.5%为差；主观结果明显更差（20%为中至差）。结果与骨折类型之间未发现统计学上的显著关系。桡尺远侧关节区域的临床畸形和疼痛很常见。17.8%的病例观察到握力下降。腕关节活动受限并不常见。发现了许多压迫性神经病变（35例患者中有41例），尤其是正中神经。相对于所研究的三个放射学参数（即桡偏、掌倾角和桡尺指数）的值，常常发现超出正常范围。复位后与随访X线片的对比研究表明，复位丢失很常见，尤其是就掌倾角而言。只有在值极其异常的情况下，频繁的放射学畸形才与明显不良的结果相关。然而，桡骨远端骨折不应被低估。保守治疗后的长期效果可能不像一般认为的那样可以接受。
