ObjectiveTo compare the effectiveness of external fixation and volar locking compression plate in the treatment of distal radius fractures of type C. MethodsBetween March 2012 and March 2013, 122 patients with distal radius fractures of type C were enrolled in the prospective randomized study. Fractures were treated by external fixation in 61 patients (external fixation group) and by open reduction and internal fixation using a volar locking compression plate in 61 patients (plate group). There was no significant difference in age, gender, fracture side, weight, height, body mass index, fracture type, and interval of injury and operation between 2 groups (P>0.05). The blood loss, operation time, hospitalization days, fracture union time, wrist function, and complications were compared between 2 groups. And the quality of reduction was observed, including volar tilting angle, ulnar deviation, radial height, and articular reduction. ResultsThe blood loss, operation time, and hospitalization days in plate group were significantly higher than those in external fixation group (P<0.05). All of the patients in both groups were followed up 12-28 months. Postoperative complications occurred in 4 patients (6.6%) of external fixation group (pin tract infection in 2 cases and radial nerve neuritis in 2 cases) and in 5 patients (8.2%) of plate group (wound infection in 1 case, carpal tunnel syndrome in 2 cases, and tendon rupture in 2 cases), showing no significant difference between 2 groups (P=0.500). The X-ray films showed fracture healing in all patients of 2 groups; the union time of plate group was significantly longer than that of external fixation group (P<0.05). At last follow-up, there was no significant difference in ulnar deviation and radial height between 2 groups (P>0.05), but the volar tilting angle of plate group was significantly larger than that of external fixation group (P<0.05). There was no significant difference in wrist function and articular reduction between 2 groups (P>0.05). ConclusionFor distal radius fractures of type C, the use of external fixation or volar locking compression plate can obtain satisfactory clinical outcomes, but the external fixation has the advantages of less invasion, shorter hospitalization days, minor complications, and faster fracture union.
ObjectiveTo investigate the effectiveness on the distal radius deformity and bone defect after trauma by using Ilizarov external fixator.MethodsThe clinical data of 9 patients of post-traumatic distal radius deformity with bone defect treated by Ilizarov technique between January 2012 and December 2016 were retrospectively analyzed. There were 7 males and 2 females with an average age of 25.6 years (range, 11-46 years). Of the 9 cases, 4 were radial baseball hand deformity with large bone defect, 4 were short deformity of distal radius, 1 was distal radius deformity with radial deflection and pronation deformity, all with distal dislocation of the distant radial-ulnar joint. The time from injury to operation was 6 months to 6.2 years (mean, 1.5 years). The bone defect was 1.4-6.8 cm (mean, 3.6 cm). After complete debridement, the forearm was fixed with Ilizarov external fixator. At 7 days after operation, bone transport or bone lengthening was performed at the rate of 0.8-1 mm/d, 4 times a day, the deformity was slowly corrected and the bone defect was repaired. According to the loss of palmar tilt angle and ulnar tilt angle measured before operation, the position of distal radial articular surface was gradually adjusted in the course of moving or prolonging, so as to restore palmar tilt angle and ulnar tilt angle as far as possible.ResultsAll wounds healed by first intention and no leakage or rupture occurred. All the 9 patients were followed up 15-36 months (mean, 23 months). All the radius defects healed and the distal deformity was corrected, the healing time was 92.4-138.6 days (mean, 104.7 days); the external fixation index was 32.6-51.1 days/cm (mean, 40.2 days/cm). After 2 months of external fixator removal, the wrist joint flexion was (42.6±3.1)°, the wrist dorsum extension was (48.5±4.7)°, the palm inclination angle was (11.5±1.3)°, and the ulnar deviation angle was (21.2±3.7)°; the elbow flexion was (128.2±6.4)°, the elbow extension was (3.2±2.1)°, the forearm pronation was (71.5±4.3)°, and the forearm rotation was (38.2±6.5)°; the wrist and elbow joint extension and forearm rotation were significantly improved when compared with preoperative values (P<0.05). At last follow-up, wrist function was assessed according to Gartland-Werley standard, the results were excellent in 3 cases, good in 5 cases, and fair in 1 case. Four cases had pinhole infection, and were cured after anti inflammatory dressing change or replacement of needles; 3 cases did not heal at the bone junction, and were healed after bone grafting; 4 cases deviated from the radial force line, and the deformity was corrected after adjusting the needle.ConclusionIlizarov technique can correct deformity and reconstruct bone defect of the post-traumatic distal radius simultaneously, so it is a good method to treat this kind of disease.
Objective To investigate the operative indication and clinical efficacy of combination of external fixator and volar approach fixation in treatingdistal radius fracture. Methods From March 2000 to March 2005, 28 patients with distal radius fracture were treated with combination of external fixator and volar approach fixation. Dorsal external fixator was used to maintain wrist in functional position, combinated volar plate or Kirschner wire fixation after reduction was achieved. Bone graft was necessary if there were severe comminuted cortical bone or compress of cancellous bone. Of 28 patients, there were 21 males and 7 females, aging from 1854 years with a median age of 41 years. The locations were the left side in 4 cases and the right side in 24 cases. According to typing criterion for AO, 18 cases were classified as C2 and 10 cases as C3. One case wasaccompanied with dislocation of lunate bone. Results Among 28 patients, 24 were followed up for an average of 8.5 months. The anatomical relationship of their wristjoint were reestablished and retained. Overall good to excellent results were achieved in 87%, excellent in 16 cases, good in 5 cases and fair in 3 cases. Conclusion A combination of external fixator and volar approach fixation is an effective method of treating fractures of the distal radius，because distal radius fracture is unstable or difficult to close reduction. Volarfixation can avoid operative complication, and external fixator can obtain satisfactory reduction and function.
Objective To study the cl inical outcomes of Numelock II polyaxial system in treatment of type C fractures of the distal radius. Methods From March 2006 to June 2007, 12 cases of type C distal radial fractures (6 males and 6 females)were treated with open reduction and internal fixation. The mean age of the patients was 48.2 years (34-64 years)．The locations were left wrist in 5 cases and right wrist in 7 cases, including 1 case of old fracture and 11 cases of fresh fractures. All fractures were closed. The mean course of disease was 9 days and 7 hours (4 hours to 60 days). According to AO/ASIF classification, there were 4 cases of C1 type, 5 cases of C2 type and 3 cases of C3 type. Preoperatively, the palmar tilt angle was —30° to 30° (— 5° on average), and the radial inclination angle was 5° to 13° (7.7° on average), and the radial shortening was 5 mm to 15 mm (9 mm on average). One case combined with dislocation of elbow joint and 2 cases combined with multi ple injuries. Results All incision healed by first intention. Postoperative follow-up ranged from 14 months to 29 months (15.6 months on average). The X-ray films showed that the union of fractures was achieved 6-8 weeks (6.6 weeks on average). No screws breakage occurred. The articular facets weresmooth in 11 of 12 patients. After operation, the palmar tilt angle was 0° to 15° (6.7° on average), and the radial inclination angle was 5° to 15° (10.2° on average), showing significant differences when compared with those before operation (P lt; 0.05). All the radial shortening was corrected. The ROM of the wrist was 55%-100% of the normal side. The grip strength was 55%-90% of the normal side. The results were excellent in 9 cases, good in 2 cases, and poor in 1 cases by X-ray film and wrist function assessment, the excellent and good rate was 91.7%. Conclusion Numelock II polyaxial system fixation is an ideal method to treat type C fractures of the distal radius. Numelock II polyaxial mechanism may provide the free adjustabil ity of screw trajectories and a higher degree of overall stabil ity compared to monoaxial locking plates.
Objective To determine the cl inical results of locking plate system in the treatment of distal radial fractures. Methods From May 2004 to November 2006, 75 patients were treated with 2.4 mm locking plate system. There were 41 males and 34 females, with a mean age of 51 years old (range, 13-82 years old). The locations were left side in 34 casesand right side in 41 cases. The cause of injury was a low energy fall in 49 cases, fall ing from height in 14 cases, traffic accident in 6 cases and sports injuries in 6 cases. All patients were diagnosed as having closed fracture. According to Müller-AO classification, there were 14 cases(18.7%) of type A, 5 cases(6.7%) of type B, and 56 cases(74.6%) of type C. The time from injury to operation was 5 hours to 27 days (mean 6 days). Results A total of 75 patients were followed up at 3 months, 71 patients at 6 months, 68 patients at 1 year and 51 patients at 2 years. Heal ing by first intention of incision was achieved in 73 cases, and infection occurred in 2 cases. Fracture reduction failed at 1 month, 3 months and 6 months in 1 case, respectively; 1 case received plaster fixation and 2 cases received re-fixation and autograft of il ium; and fracture healed in 3 cases at last follow-up. Two patients complained of skin numbness at site of superficial branch of radial nerve after 1 day, 1 patient had wound pain after operation, and 1 patient had infection of tendon at 3 days and 5 days in 1 case respectively. At last follow-up, the ranges of motion of wrist joint were (80 ± 9)° for pronation, (86 ± 7)° for supination, (57 ± 10)° for dorsal flexion, (51 ± 13)° for palmar flexion, (18 ± 7)° for radial incl ination, and (28 ± 7)° for ulnar deviation. According to modified Green scoring, the results were excellent in 66 cases, good in 6 cases and poor in 3 cases. At last follow-up, according to Knirk criterion for osteoarthritis, there were 22 cases of grade I and 5 cases of grade II, and all were classified as type C. Conclusion Internal fixation of distal radial fractures with 2.4 mm locking plate system provided a stable fixation with good cl inical outcomes.
Objective To systematically review the value of ultrasound in the diagnosis of fracture of the distal radius and ulna for providing evidence for clinical diagnosis. MethodsWe searched PubMed, EMbase, The Cochrane Library (Issue 7, 2016), CNKI, CBM and WanFang Data databases for studies about ultrasound in the diagnosis of fracture of the distal radius and ulna from inception to August 1st, 2016. Two reviewers independently screened literatures according to inclusion and exclusion criteria, extracted data, and assessed the risk of bias of included studies by using the QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies 2) tool, and then meta-analysis was performed by using Meta-Disc 1.4 software. ResultsA total of 16 articles involving 1 182 patients and 631 fractures were included. The results of heterogeneity test revealed that there was statistical heterogeneity among the results of studies, thus, random effects model was used for meta-analysis. The results of meta-analysis showed that the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnosis odds ratio for ultrasound diagnosis fracture of the distal radius and ulna were 0.95 (95%CI 0.94 to 0.97), 0.92 (95%CI 0.89 to 0.94), 9.98 (95%CI 5.20 to 19.15), 0.07 (95%CI 0.04 to 0.13), 187.94 (95%CI 65.67 to 537.84), respectively. The area under the SROC curve was 0.976 4. ConclusionUltrasound is a useful non-invasive method as a routine examination for fracture of the distal radius and ulna. Due to the limited quality and quantity of included studies, the above conclusion is needed to be validated by more high-quality studies.
Objective To analyze the effectiveness of volar locking compression plate (LCP) and radial styloid process plate for the treatment of type C fractures of the distal radius. Methods Between May 2010 and May 2011, 24 cases of type C fractures of the distal radius were treated, including 8 males and 16 females with an average age of 52 years (range, 23-73 years). Injury was caused by falling in 20 cases and by traffic accident in 4 cases. All were fresh closed fractures. The locations were the left side in 15 cases and the right side in 9 cases. According to AO typing, there were 16 cases of type C2 and 8 cases of type C3. The preoperative palmar tilt angle ranged from — 60 to 25° (mean, — 45.3°); the preoperative ulnar inclination angle ranged from — 16 to 13° (mean, 8.2°); and the preoperative radial length shortening was 8-18 mm (mean, 12 mm). The time from injury to operation was 3-10 days (mean, 5.2 days). Results All operation incisions healed primarily. All patients were followed up 9-16 months (mean, 13.5 months). The healing time of fracture was 8-12 weeks (mean, 10.2 weeks). The articular surface was smooth and the radial length was recovered. The postoperative palmar tilt angle ranged from 8 to 15° (mean, 12.3°); the postoperative ulnar inclination angle ranged from 18 to 26° (mean, 22.3°). No loss of reduction, refracture, or carpal tunnel syndrome occurred during follow-up. The average range of motion of the wrist was 45.3° (range, 30-70°) in dorsal extension, was 50.2° (range, 26-78°) in palmar flexion, was 13.5° (range, 8-25°) in radial inclination, was 23.6° (range, 15-32°) in ulnar inclination, was 65.7° (range, 35-90°) in pronation, and was 72.5° (range, 20-90°) in supination at last follow-up. According to the wrist function by Gartland-Werley scoring, the results were excellent in 12 cases, good in 8 cases, and fair in 4 cases; and the excellent and good rate was 83.3%. Conclusion Treatment of type C fractures of the distal radius with volar LCP and radial styloid process plate can reconstruct normal anatomic structures and get good functional recovery.