Rettig M E, Dassa G L, Raskin K B, Melone C P
Department of Orthopaedic Surgery, New York University Medical Center, New York, USA.
Clin Sports Med. 1998 Jul;17(3):469-89. doi: 10.1016/s0278-5919(05)70097-1.
The primary prerequisites for optimal management of the athlete's fractured wrist are prompt diagnosis, anatomic and stable reduction, effective immobilization until healing is thorough, and comprehensive rehabilitation of the injured parts. Fulfillment of these fundamental criteria consistently leads to a highly favorable outcome with minimal risk of re-injury. In contrast, a compromise of these principles, especially for the sake of a speedy return to sports, invariably results in suboptimal recovery and, not infrequently, a permanent loss of skills. The exceptions to the cardinal rule that successful treatment of wrist fractures requires precise restoration of anatomic relationships are specific: displaced hamate hook fractures, displaced trapezial ridge fractures, and comminuted pisiform fractures. In such instances, successful union essentially is precluded, and early excision of the displaced fragments is the logical means of facilitating an uncomplicated recovery. For the more complex fractures requiring stabilization, continual refinements in methods of fixation are considerably diminishing fracture morbidity. The availability of small screws that provide rigid fixation of the carpus is, with increasing consistency, promoting accelerated union and rapid rehabilitation. Well-conceived combinations of low-profile, mechanically efficient external fixators and precisely used Kirschner wires achieve highly secure fracture stability for the distal radius that similarly enhances recovery with a minimum of complications. Improvements in both design and application of internal and external fixation techniques undoubtedly constitute a major advance in the management of wrist fractures among athletes. For some athletes, the return to competition can be safely expedited by the use of custom-fit protective gloves, splints, or casts. For most, however, the treatment regimen usually entails a minimum of 3 to 4 months. Although the healing and rehabilitation process is often lengthy and may seem costly, particularly in terms of time lost from competition, seldom do athletes regret the investment once they return to their highly skillful activities unencumbered by wrist impairment. Never does the sports medicine physician regret compliance with the principles of optimal care.
对运动员手腕骨折进行最佳治疗的主要先决条件包括及时诊断、解剖复位并保持稳定、在骨折完全愈合前进行有效固定，以及对受伤部位进行全面康复。始终满足这些基本标准会带来非常理想的结果，再次受伤的风险极小。相反，违背这些原则，尤其是为了迅速重返运动而妥协，必然会导致恢复不佳，而且常常会导致永久性的技能丧失。成功治疗腕部骨折需要精确恢复解剖关系这一基本原则的例外情况很特殊：移位的钩骨钩骨折、移位的大多角骨嵴骨折和粉碎性豌豆骨骨折。在这种情况下，基本上无法实现成功愈合，早期切除移位的骨折碎片是促进顺利康复的合理方法。对于需要稳定固定的更复杂骨折，固定方法的不断改进正在显著降低骨折的发病率。能够提供腕骨牢固固定的小螺钉越来越多地促进了骨折的加速愈合和快速康复。精心设计的低轮廓、机械效率高的外固定器与精确使用的克氏针相结合，可为桡骨远端实现高度可靠的骨折稳定性，同样能以最少的并发症促进康复。内固定和外固定技术在设计和应用方面的改进无疑是运动员腕部骨折治疗的一项重大进展。对于一些运动员来说，使用定制的防护手套、夹板或石膏可以安全地加快重返比赛的速度。然而，对于大多数运动员来说，治疗方案通常至少需要3至4个月。尽管愈合和康复过程通常漫长且看似代价高昂，尤其是从失去比赛时间的角度来看，但一旦运动员能够不受手腕损伤的影响，顺利恢复到他们技艺高超的运动中，他们很少会后悔为此付出的努力。运动医学医生也从不后悔遵循最佳治疗原则。
