Bégué T, Judet T, de Thomasson E, Rouvreau P, de Cheveigné C, Garreau de Loubresse C, Boury G
Service de Chirurgie Générale et Traumatologique, Hôpital Tenon, Paris.
Ann Chir Main Memb Super. 1995;14(1):5-13. doi: 10.1016/s0753-9053(05)80528-9.
Goals for treatment of comminutive fractures of the distal radius include restoration of the articular profile of the proximal part of the joint, while axial loading forces must be avoided as much as possible to prevent secondary displacement. The choice of an internal fixation protected by an external wrist distractor-fixator, with early activo-passive mobilisation, seems to achieve the goal. Twelve patients with a comminuted fracture of the distal radius, including axial articular impigment displacement were reviewed for this study. All fractures were Frykman's type III, IV, VII or VIII. Distraction was done with a specific external apparatus, allowing an internal fixation, using an anterior plate and posterior Kirschner wires for the more complex cases. Distraction was released at the end of the surgical procedure, while the distractor was left in place. The wrist was mobilised early in the post-operative period, and the distractor was removed two months later. At a mean follow-up of 8.5 months, two patients were still painful. Mean motion of the wrist joint was 115 degrees for flexion-extension and 35 degrees for radio-ulnar deviation. Radiological results were good (10 cases), in both planes sagittal and frontal, and stable with time. The radio-ulnar index was correct in 11 cases. Only two cases of Sudeck's atrophy were noted. Authors use a specific external wrist distractor to obtain and maintain reduction in comminuted fractures of the distal end of the radius, using internal fixation in combination. Early motion of the wrist, protected by the wrist distractor seems to lower rates of Sudeck's atrophy.
桡骨远端粉碎性骨折的治疗目标包括恢复关节近端的关节面形态，同时必须尽可能避免轴向负荷力，以防止继发性移位。选择一种由外部腕部牵引固定器保护的内固定方法，并早期进行主动-被动活动，似乎可以实现这一目标。本研究回顾了12例桡骨远端粉碎性骨折患者，包括轴向关节撞击移位。所有骨折均为弗赖克曼III型、IV型、VII型或VIII型。使用一种特殊的外部器械进行牵引，以便进行内固定，对于更复杂的病例，使用前路钢板和后路克氏针。手术结束时松开牵引，同时将牵引器留在原位。术后早期对手腕进行活动，两个月后取出牵引器。平均随访8.5个月时，2例患者仍有疼痛。腕关节屈伸平均活动度为115度，桡尺偏平均活动度为35度。矢状面和额状面的影像学结果均良好（10例），且随时间推移保持稳定。11例患者的桡尺指数正常。仅发现2例苏戴克萎缩。作者使用一种特殊的外部腕部牵引器，结合内固定来获得并维持桡骨远端粉碎性骨折的复位。由腕部牵引器保护的腕关节早期活动似乎可以降低苏戴克萎缩的发生率。
