Labbe J L, Peres O, Leclair O, Goulon R, Bertrou V, Saint-Lanne S
Service de Chirurgie Orthopédique et Traumatologique, Centre Hospitalier Territorial de Nouméa, Nouvelle-Calédonie.
Rev Chir Orthop Reparatrice Appar Mot. 1998 Oct;84(6):515-22.
The authors report a study from a series of 113 adults treated by osteosynthesis in a seven year period, for an adult isolated ulnar shaft fracture by osteosynthesis. These patients were divided into two groups: 57 patients treated by open reduction and AO plate fixation (group n(o) 1), and 56 patients operated by percutaneous intramedullary nailing, according to Böhler technique, with a simple Kirschner pin suited into the medullary canal (group n(o) 2).
For this ulnar fracture, the proportion of men and women was equal, with an average age of 37 years, predominant on the left limb (61 per cent). The most common cause was direct trauma (71 per cent): Böhler's "parry fracture", followed by traffic accidents (14 per cent), and 6 per cent by falls. We never found, in this series, indirect fractures by fall on the hand palm, and never clinical or radiological objective signs for a suspected lesion of the proximal and distal joints. Both operative procedures are described, with a particular emphasis on the simplicity of the nailing technique. No immobilization, of any kind, was applied, and patients were allowed to start full movements of the wrist and elbow, immediately after surgery.
There were no early post operative complications, but great differences in the evolution between both groups. In group n(o) 1, there was a 29.8 per cent complication rate, 47 per cent of this was considered as "major" including osteomyelitis, non union, plate breakage, screw loosening, refractures. Patients in group n(o) 2, suffered only a few "minor" complications. Functional and anatomical results were also better in group 2 with earlier return to work.
Isolated fracture of the ulnar shaft in the adult is known as a problematic fracture which needs long time to unite and often ends in non union. If opinion varies between plaster or internal fixation, we have abandoned the conservative treatment for the osteosynthesis. In order to demonstrate that intramedullary nailing technique gives a "sufficient" fixation, the authors pointed out the biomechanical importance of soft tissues structure preservation.
Percutaneous intramedullary nailing of isolated ulnar shaft fractures in adult, is a simple and inexpensive technique, which gives predictable bone union, without particular complication and without drawbacks of other internal fixation techniques.
作者报告了一项对113例成年人进行为期7年的接骨术治疗的研究，这些患者均为成人单纯尺骨干骨折并接受接骨术治疗。这些患者被分为两组：57例接受切开复位和AO钢板固定治疗（第1组），56例采用经皮髓内钉固定术，根据Böhler技术，使用一根简单的克氏针插入髓腔（第2组）。
对于该尺骨骨折，男女比例相同，平均年龄37岁，以左侧肢体为主（61%）。最常见的原因是直接创伤（71%）：Böhler氏“格挡骨折”，其次是交通事故（14%），6%为跌倒。在本系列研究中，我们从未发现因手掌着地导致的间接骨折，也从未发现近端和远端关节疑似损伤的临床或放射学客观体征。文中描述了两种手术方法，特别强调了髓内钉固定技术的简便性。术后未采用任何形式的固定，患者术后可立即开始进行腕关节和肘关节的全范围活动。
术后早期无并发症，但两组的病情发展存在很大差异。在第1组中，并发症发生率为29.8%，其中47%被认为是“严重”并发症，包括骨髓炎、骨不连、钢板断裂、螺钉松动、再骨折。第2组患者仅出现少数“轻微”并发症。第2组的功能和解剖学结果也更好，患者能更早重返工作岗位。
成人单纯尺骨干骨折是一种棘手的骨折，愈合时间长，常导致骨不连。虽然对于石膏固定还是内固定存在不同观点，但我们已放弃保守治疗而采用接骨术。为了证明髓内钉固定技术能提供“足够”的固定，作者指出了保留软组织结构的生物力学重要性。
成人单纯尺骨干骨折的经皮髓内钉固定术是一种简单且经济的技术，能实现可预测的骨愈合，无特殊并发症，也没有其他内固定技术的缺点。
