Kuderna H
Orthopade. 1986 Apr;15(2):95-108.
Most carpal fractures are based on the same injury mechanism. In most cases the injury is caused by a fall on the dorsiflexed hand, which is raised as a protective measure, and less frequently by a fall on the clenched fist. The latter leads to passive palmar flexion, pronation and radial inclination of the hand; in the former, the hand is passively superextended by the impact, supinated, and brought into ulnar inclination. The instability caused by injury to various articular structures has four developmental stages. The bones or syndesmoses that are involved depend on the stage and quantitative relationship between the three above-mentioned moments of force. If the lateral ligament of the wrist is slack, scaphoid fractures occur; in the last stage of superextension, fractures of the capitate bone occur. With increasing ulnar inclination, perilunar dislocations or fracture-dislocations and triquetrum fractures occur in the third stage and dislocations of the semilunar bone in the fourth stage. In addition, compression and avulsion of the 1st, 4th or 5th metacarpal bones cause fractures of the trapezium and the hamate bone. To avoid unpleasant late sequels, scaphoid fractures with diastasis due to soft tissue interposition or non-reducible dislocated scaphoid fractures must be treated surgically. Vertical oblique fractures and scaphoid fractures with small proximal fragments are relatively good indications for operation. Perilunar instability and dislocations, particularly De Quervain's fracture-dislocations, must be treated operatively because reduction of the scaphoid bone requires a different approach than correcting alignment in the carpus and because soft tissue interpositions are always present, even though they may not be evident in the X-ray pictures. Fracture-dislocations in the distal carpal row also require operation, preferably percutaneous internal fixation using K-wire and fluoroscopy. Immobilization is accomplished by a below-elbow cast with a dorsal plaster splint up to the interdigital webs and from the palmar to the proximal crease. The thumb is only embedded in trapezium fractures; fractures requiring fist or above-elbow casts are indications for operation.
大多数腕骨骨折基于相同的损伤机制。在大多数情况下，损伤是由于手背屈位着地（手作为一种保护措施抬起）所致，较少见的是握拳着地。后者导致手被动掌屈、旋前和桡偏；前者中，手因撞击而被动过度伸展、旋后并尺偏。各种关节结构损伤所致的不稳定有四个发展阶段。所累及的骨骼或韧带联合取决于上述三种力的阶段及数量关系。如果腕关节外侧韧带松弛，会发生舟骨骨折；在过度伸展的最后阶段，会发生头状骨骨折。随着尺偏增加，在第三阶段会发生月骨周围脱位或骨折脱位以及三角骨骨折，在第四阶段会发生月骨脱位。此外，第1、4或5掌骨的压缩和撕脱会导致大多角骨和钩骨骨折。为避免出现不良的后期后遗症，因软组织嵌入导致分离的舟骨骨折或不可复位的脱位舟骨骨折必须进行手术治疗。垂直斜形骨折和近端小碎片的舟骨骨折是相对较好的手术指征。月骨周围不稳定和脱位，尤其是桡骨茎突骨折脱位，必须进行手术治疗，因为舟骨复位需要不同于腕骨对线矫正的方法，而且即使在X线片上可能不明显，但软组织嵌入总是存在。腕骨远侧列的骨折脱位也需要手术，最好采用克氏针经皮内固定并在透视下操作。通过使用背侧石膏夹板的肘下石膏固定，固定范围至指间蹼，从掌侧到近端皱折处。仅在大多角骨骨折时将拇指固定；需要握拳或肘上石膏固定的骨折是手术指征。
