Thusoo Varun, Chakrapani Arjun S, Nehru Ashish, Kudyar Sachin, Nagpal Brahmpreet, Kv Alok, S Ebin, Jose Akhil
Department of Orthopaedics, Royal Shrewsbury Hospital NHS Trust (SaTH), Shrewsbury, GBR.
Department of Orthopaedics and Traumatology, St. Thomas' Hospital, London, GBR.
Cureus. 2024 Nov 22;16(11):e74226. doi: 10.7759/cureus.74226. eCollection 2024 Nov.
The objectives of this study are to determine the functional outcomes and compare them between conservative and surgical management in patients managed for closed-type intra-articular distal end of radius fractures.
A prospective observational study was done on 150 patients who underwent treatment for closed-type intra-articular distal end of radius fractures. As per Frykman Classification, they were type III. Patients were either managed conservatively, i.e. 100 patients out of 150 and surgical management was done in 50 cases. For surgical management, implants used were K-wires, Schanz pins, and Ellis Plate. The functional outcomes were noted in terms of pain and range of motion, in the follow up of six months. Union was noted clinically and radiologically.
The mean age of the study patients was 42.32 ± 15.77 years. Out of 150 patients, there were 100 (66.67%) male patients. Compared to conservative management, surgical management had significantly lesser time of union (12 vs. 20 weeks, P<0.0001); significantly more excellent results (44% vs. 30%), more good results (32% vs. 15%) (P=0.003); comparable pain score (P=0.236); and comparable functional score (P=0.661). Regarding radiological outcomes, surgical management had significantly more volar tilt (9.6±2.5° vs. 8±5°, P=0.035); lesser Ulnar variance (3±2 vs. 4±2 mm, P=0.004), lesser grip strength <50% (26% vs. 65%, P<0.0001); comparable radial inclination (21±4° vs. 20±5°, P=0.661); and comparable radial height (11±3 vs. 10±5 mm, P=0.195) Conclusion: To conclude, surgery for distal radius fractures promotes faster healing, lesser pain, lesser malunion, and better functional outcomes. However, it is not without potential risks. Non-surgical treatment is still a suitable option, for patients with contraindications to surgery or having lower need for functional improvement.
本研究的目的是确定闭合型桡骨远端关节内骨折患者的功能结局，并比较保守治疗和手术治疗的效果。
对150例闭合型桡骨远端关节内骨折患者进行了一项前瞻性观察研究。根据Frykman分类，他们属于III型。患者要么接受保守治疗，即150例中的100例，50例进行了手术治疗。手术治疗使用的植入物有克氏针、斯氏针和埃利斯钢板。在六个月的随访中，记录了疼痛和活动范围方面的功能结局。临床和影像学检查记录骨折愈合情况。
研究患者的平均年龄为42.32±15.77岁。150例患者中，男性患者有100例（66.67%）。与保守治疗相比，手术治疗的骨折愈合时间明显更短（12周对20周，P<0.0001）；优秀结果明显更多（44%对30%），良好结果更多（32%对15%）（P=0.003）；疼痛评分相当（P=0.236）；功能评分相当（P=0.661）。关于影像学结局，手术治疗的掌倾角明显更大（9.6±2.5°对8±5°，P=0.035）；尺骨变异更小（3±2对4±2mm，P=0.004），握力<50%的情况更少（26%对65%，P<0.0001）；桡骨倾斜度相当（21±4°对20±5°，P=0.661）；桡骨高度相当（11±3对10±5mm，P=0.195）结论：总之，桡骨远端骨折手术可促进更快愈合、减轻疼痛、减少畸形愈合并获得更好的功能结局。然而，手术并非没有潜在风险。对于有手术禁忌证或功能改善需求较低的患者，非手术治疗仍是一种合适的选择。
