Department of Orthopaedics, Faculty of Medicine, University of British Columbia, 11th Floor-2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada.
Division of Orthopaedic Trauma, Vancouver General Hospital, 3rd Floor-2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada.
Arch Orthop Trauma Surg. 2023 Aug;143(8):5095-5103. doi: 10.1007/s00402-023-04904-z. Epub 2023 May 13.
A repeated closed reduction ("re-reduction") of a displaced distal radius fracture is a common procedure performed to obtain satisfactory alignment and avoid surgery when the initial reduction is deemed unsatisfactory. However, the efficacy of re-reduction is unclear. Compared to a single closed reduction, does a re-reduction of a displaced distal radius fracture: (1) improve radiographic alignment at the time of fracture union and, (2) decrease the rate of operative intervention?
Retrospective cohort analysis of 99 adults aged 20-99 years with extra-articular or minimally displaced intra-articular, dorsally angulated, displaced distal radius fracture with or without an associated ulnar styloid fracture who underwent a re-reduction, compared against 99 adults matched for age and sex who were managed with a single reduction. Exclusion criteria were skeletal immaturity, fracture-dislocation and articular displacement greater than 2 mm. Outcome measures included radiographic alignment at fracture union and rate of surgical intervention.
At 6-8 weeks follow-up, the single reduction group had greater radial height (p = 0.045, CI 0.04 to 3.57), and less ulnar variance (p < 0.001, CI - 3.08 to - 1.00) compared to the re-reduction group. Immediately following re-reduction, 49.5% of patients met radiographic non-operative criteria, but by 6-8 weeks follow-up, only 17.5% of patients continued to meet these criteria. Patients in the re-reduction group were treated with surgery 34.3% of the time, compared to 14.1% of the time for patients in the single reduction group (p = 0.001). In patients aged under 65 years, 49.0% of those who underwent a re-reduction were managed with surgery, compared to 21.0% of those who had a single reduction (p = 0.004).
A re-reduction performed to improve radiographic alignment and avoid surgical management in this subset of distal radius fractures had minimal value. Alternative treatment options should be considered before attempting a re-reduction.
对于桡骨远端骨折，反复闭合复位（“再复位”）是一种常见的手术，当初次复位不满意时，可通过该手术获得满意的对线，并避免手术。但是，再复位的效果并不明确。与单次闭合复位相比，再复位桡骨远端骨折：（1）是否能改善骨折愈合时的影像学对线，（2）是否能降低手术干预的发生率？
对 99 名 20-99 岁的成年人进行回顾性队列分析，这些成年人有桡骨远端背侧成角的关节外或轻度关节内、无移位或伴有尺骨茎突骨折的骨折，这些患者接受了再复位治疗，与 99 名年龄和性别匹配的仅接受单次复位的成年人进行对比。排除标准为骨骼未成熟、骨折脱位和关节面移位大于 2 毫米。主要观察指标为骨折愈合时的影像学对线和手术干预率。
在 6-8 周的随访中，单次复位组的桡骨高度更高（p=0.045，CI 0.04-3.57），尺侧偏距更小（p<0.001，CI-3.08 至-1.00）。与再复位组相比，再复位后立即有 49.5%的患者符合影像学非手术标准，但在 6-8 周的随访中，只有 17.5%的患者继续符合这些标准。再复位组中有 34.3%的患者接受了手术治疗，而单次复位组中只有 14.1%的患者接受了手术治疗（p=0.001）。在 65 岁以下的患者中，有 49.0%的再复位患者接受了手术治疗，而单次复位的患者只有 21.0%（p=0.004）。
在桡骨远端骨折的这一亚组中，为改善影像学对线和避免手术治疗而进行的再复位效果甚微。在尝试再复位之前，应考虑其他治疗选择。
