Objective To investigate the surgical technique and effectiveness of volar locking plates for senile delayed distal radius fractures. Methods Between October 2014 and September 2015, 25 cases of delayed distal radius fractures were treated by volar locking plates. There were 3 males and 22 females with an average age of 73 years (range, 65-87 years). Injury was caused by tumble in 19 cases and by traffic accident in 6 cases. All the cases had closed fracture. According to the AO classification, 10 cases were rated as type A2, 7 cases as type A3, 3 cases as type B3, and 5 cases as type C1. The manual reduction and plaster immobilization were performed in 18 cases first, but reduction failed; no treatment was given in 7 cases before surgery. The time from injury to surgery was from 33 to 126 days (mean, 61 days). Preoperatively, the volar tilting angle was (–16.0±3.1)°; the ulnar inclining angle was (10.8±7.0)°; the radial shortening was (11.2±3.6) mm; the wrist range of motion was (41.0±7.5)° in flexion and was (42.0±6.3)° in extension; and the grip strength was 33.0%±3.1% of normal side. Results All incisions healed primarily, and no postoperative complication occurred. The patients were followed up 1-1.5 years (mean, 1.3 years). The X-ray films showed that fracture union was achieved in all the patients, with the mean healing time of 9.2 weeks (range, 8-12 weeks); the displacement of the articular surface was less than 1 mm. At last follow-up, the volar tilting angle was (13.1±3.2)°; the ulnar inclining angle was (21.9±4.6)°; the radial shortening was (2.0±1.1) mm; the wrist range of motion was (52.0±11.7)° in flexion and was (65.0±4.8)° in extension; and the grip strength was 84.0%±4.2% of normal side; all showed significant difference when compared with preoperative ones (P<0.05). According to the Gartland and Werley score, the results were excellent in 15 cases, good in 6 cases, fair in 2 cases, and poor in 2 cases at last follow-up; the excellent and good rate was 84%. Conclusion By the good design of the volar locking plate and the command of surgical techniques, good effectiveness can be achieved in the treatment of senile delayed distal radius fracture.
Objective To compare the differences between volar and dorsal plate positions in the treatment of unstable fracture of distal radius. Methods From June 2000 to December 2006, 61 cases with fracture of distal radius weretreated, 27 males and 34 females aged 22-70 years (55.5 years on average), among which 18 cases were caused by traffic accidents and 43 cases falls. All cases were fresh closed fractures. All patients had AP and lateral X-ray films of the wrist preoperatively and 30 cases experienced CT scan. According to AO, there were 25 cases for B1, 18 for B2, 7 for B3, 7 for C1, and 4 for C2. All the cases were randomized into 2 groups: the wrist palmar group (group A, n=34) and dorsal group (group B, n=27), to perform volar and dorsal plate fixation, respectively. As to the measurement of fortune for the preoperative ruler and incl ination angle, group A were (—45.0 ± 53.0)º and (8.6 ± 3.1)º, respectively, and group B were (—40.0 ± 30.0)º and (7.3 ± 5.6)º, respectively. Preoperative radial shortened (12.0 ± 5.3) mm in group A, and (10.3 ± 4.2) mm in group B. Joint surface level was (4.3 ± 2.2) mm in group A, and (4.1 ± 3.3) mm in group B. Results All of the 61 cases were followed up for 6-27 months (16 months on verage). All the fractures were healed, the time to heal ing in group A was (8.2 ± 1.6) weeks, and in group B was (8.1 ± 1.2) weeks, and the difference was not significant (P gt; 0.05). As for the wrist function by Cartland-Werley scoring at the 8th week after operation, 7 cases were excellent, 10 good, and 17 poor in group A with the choiceness rate of 50.0%, while 7 cases were excellent, 11 good and 9 poor in group B with the choiceness rate of 66.7%. There was significant difference between the two groups (P lt; 0.01). And at the 24th week after operation, 21 cases were excellent, 9 good, and 4 poor in group A with the choiceness rate of 88.2%, while 18 cases were excellent, 5 good, and 4 poor in group B with the choiceness rate of 85.2%. There was no significant difference between the two groups (P gt; 0.05). As for radiological assessment by Sarmiento, device and palm incl ination angles in group A were (9.5 ± 3.1)º and (18.0 ± 8.2)º, respectively, and in group B were (11.0 ± 4.7) º and (16.0 ± 7.6)º, respectively. No radial shortening was found either in group A or in group B, and joint surface level in both groups were less than 1 mm. There was no significant difference between group A and group B in terms of all indicators postoperatively (P gt; 0.05), but there was significant difference when compared with preoperation (P lt; 0.001). With regard to comparison of postoperative compl ications between the two groups, there was no significant difference (P gt; 0.05) in early postoperative compl ications, but there was in long-term compl ications (P lt; 0.01). Conclusion The volar and dorsal plate positions may offer effective stabil ity for unstable distal radial fracture and early functional exercise. The volar plate position may influence the pronation function of the wris joint in the short run, while the dorsal plate position may cause more compl ications in the long run.
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.
目的 比较外固定支架与锁定加压钢板（LCP）治疗桡骨远端die-punch骨折的疗效及适应证。 方法 2007年1月－2011年1月，分别采用外固定支架和LCP治疗桡骨远端die-punch骨折32例36侧，其中LCP固定19侧，外固定支架固定17侧。两组患者性别、年龄、致伤原因、骨折分类、伤后至入院时间等一般资料比较差异无统计学意义（P＞0.05）。术中对塌陷的关节面均采取撬拨植骨的方法恢复桡腕关节，克氏针固定较大骨折块。比较两种方法手术前后掌倾角、尺偏角、桡腕关节面恢复情况、骨折愈合时间，术后腕关节活动范围等。 结果 两组患者手术切口均Ⅰ期愈合，无感染发生。患者术后均获随访，随访时间6～24个月，平均13个月。所有患者骨折愈合良好，愈合时间、术后6个月X线片掌倾角、尺偏角两组间差异均无统计学意义（P＞0.05）；术后6个月腕关节尺偏活动度分别为（20.8 ± 3.6）°和（18.0 ± 2.8）°，LCP组优于外固定支架组（P＜0.05）；LCP组和外固定支架组桡骨高度分别为（10.9 ± 2.8）mm和（13.4 ± 2.3）mm，Gartland-Werley评分分别为（5.3 ± 2.4）分和（8.4 ± 3.6）分，两组差异有统计学意义（P＜0.05）。 结论 对于桡骨远端die-punch骨折，LCP可提供有效固定及早期活动，但对于关节面的塌陷及桡骨高度的恢复，外固定支架固定可提供良好的支撑作用。对于严重die-punch骨折可联合运用LCP和外固定支架等技术。
Objective To evaluate the effect of associated ulnar styloid fracture on wrist function after distal radius fracture by comparing the cl inical data between the cases of distal radius fracture with or without ulnar styloid fractures. Methods The cl inical data of 182 patients with distal radius fracture between February 2005 and May 2010 were retrospectively analyzed, including 75 with ulnar styloid fracture (group A), and 107 without ulnar styloid fracture (group B). There was no significant difference in sex, age, disease duration, and fracture classification between 2 groups (P gt; 0.05). In groups A and B, closed reduction and spl intlet or cast fixation were performed in 42 and 63 cases respectively, and openreduction and internal fixation in 33 and 44 cases respectively. All ulnar styloid fractures were not treated. Results Thepatients were followed up 21 months on average in group A and 20 months on average in group B. All incisions healed by first intention after operation. Ulnar wrist pain occurred in 4 patients (5.3%) of group A and 6 patients (5.6%) of group B, showing no significant difference (χ2=0.063, P=0.802). The fracture heal ing time was (10.9 ± 2.7) weeks in group A and (11.6 ± 2.3) weeks in group B, showing no significant difference (t=1.880, P=0.062). There was no significant difference in the palmar tilt angle, the ulnar incl ination angle, and the radial length between groups A and B when fracture healing (P gt; 0.05). At last follow-up, there was no significant difference in wrist flexion-extension, radial-ulnar deviation, pronation-supination, and grip and pinch strength between 2 groups (P gt; 0.05). According to the Gartland-Werley score in groups A and B, the results were excellent in 24 and 35 cases, good in 43 and 57 cases, fair in 5 and 10 cases, and poor in 3 and 5 cases with execllent and good rate of 89.3% and 86.0%, respectively, showing no significant difference between 2 groups (Z= —0.203, P=0.839). There were significant differences in the above indexes between patients undergoing closed reduction and open reduction in group A (P lt; 0.05). Conclusion Associated ulnar styloid fracture has no obvious effect on the wrist function after distal radius fracture. The anatomical reduction of distal radial fracture is the crucial importance in the treatment of distal radial fracture accompanying ulnar styloid fracture.
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 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.