Maliyappa Chandrashekara, Raghupathi Anantha, Rupasinghe Dilupa, Iancu Persidiu, Mohamed Muawia, Qazzaz Layth
Department of Trauma and Orthopaedics, Southend University Hospital, Westcliff on Sea, Essex, United Kingdom.
J Orthop Case Rep. 2023 Oct;13(10):53-57. doi: 10.13107/jocr.2023.v13.i10.3934.
COVID-19 pandemic created extreme pressure situation on health care services across the globe with shortage of medical staff and beds. The management of fragility fracture also affected significantly. The distal radius fractures (DRFs) are one of the common frailty fractures. There was a significant shift in the treatment of such injuries with new guidelines leaning toward more of non-operative management.
A retrospective cross-sectional study of DRFs (DRF) treated during COVID pandemic for a period of 1 year in the United Kingdom. This included all radiologically confirmed cases of DRFs with isolated adult injuries excluding polytrauma, same limb other injuries, associated neurovascular injuries, and age below 18 years. All patient's data were collected from hospital records retrospectively from April 2020 to March 2021. There were a total of 179 patients with distal radius fracture, of which 141 (78.8%) were females and 38 (21.2%) males. The mean age was 68.2 years (SD 68.20 ± 15.63) and there were greater number of patients with intra-articular fracture. There were 28.5% (Grades 1 and 2, Group I) extra-articular fractures; 69.8% (Grades 3-8, Group II) were intra-articular fractures and 3 Barton's fractures (Group III) accounted to 1.7%. 137 patients were (76.5%) treated to non-operatively and 42 (23.5%) were treated surgically. 135 (75.4%) patients had good and 43 (24%) satisfactory clinical outcomes. 3 (1.6%) patients required osteotomy for malunited fractures. Fracture grade I and II is significantly associated with non-operative procedure (100.0% vs 84.3%) with P < 0.001.
This study confirmed that non-operative treatment is still a good option even in intra-articular fractures. Surgical fixation should be considered in young patients and those with higher grade of fracture classification and greater angulation at presentation. A virtual physiotherapy is still a good option.
新冠疫情给全球医疗服务带来了巨大压力，导致医护人员和床位短缺。脆性骨折的管理也受到了显著影响。桡骨远端骨折（DRF）是常见的脆性骨折之一。随着新指南倾向于更多的非手术治疗，此类损伤的治疗发生了重大转变。
一项对英国在新冠疫情期间1年内治疗的桡骨远端骨折（DRF）的回顾性横断面研究。这包括所有经放射学确诊的孤立成人桡骨远端骨折病例，排除多发伤、同一肢体的其他损伤、相关神经血管损伤以及18岁以下患者。所有患者的数据均从2020年4月至2021年3月的医院记录中回顾性收集。共有179例桡骨远端骨折患者，其中141例（78.8%）为女性，38例（21.2%）为男性。平均年龄为68.2岁（标准差68.20±15.63），关节内骨折患者数量较多。28.5%（1级和2级，第一组）为关节外骨折；69.8%（3 - 8级，第二组）为关节内骨折，3例巴顿骨折（第三组）占1.7%。137例患者（76.5%）接受了非手术治疗，42例（23.5%）接受了手术治疗。135例（75.4%）患者临床效果良好，43例（24%）患者临床效果满意。3例（1.6%）患者因骨折畸形愈合需要进行截骨术。骨折I级和II级与非手术治疗显著相关（100.0%对84.3%），P<0.001。
本研究证实，即使是关节内骨折，非手术治疗仍是一个不错的选择。对于年轻患者以及骨折分类级别较高且就诊时角度较大的患者，应考虑手术固定。虚拟物理治疗仍是一个不错的选择。
