摘要:

Summary:Fractures of the distal radius are a common injury treated by orthopaedic and hand surgeons. While the vast majority of these fractures can be treated conservatively with casting, those that are unstable or irreducible should be considered for operative intervention to optimize function. Operative options are improving and becoming increasingly available and should be considered whenever circumstances warrant. These fractures should not be treated in isolation but in conjunction with an adequate social history so that appropriate treatment is chosen. Physicians caring for these patients should not only be aware of all conservative and operative choices but also should participate in order to facilitate evaluation for osteoporosis and risk for other fractures, areas where early intervention can significantly improve future quality of life.

ISSN:0885-9698    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Summary:The orthopaedic community has recently witnessed a surge of interest in the surgical treatment of fractures of the distal radius. A number of studies comparing internal osteosynthesis and external fixation have been published, although comparative analyses of clinical results with nonsurgical methods of treatment have not been performed in recent times. Most comparative reports seem to focus on severely displaced fractures resulting from high‐energy injuries. These are the fractures where the value of surgical intervention is greatest because they are usually associated with a dislocation of the distal radioulnar joint. Dislocation of the distal radioulnar joint is probably the single most important prognostic feature in fractures of the distal radius. Intra‐articular incongruity per se is not necessarily the precursor of osteoarthritis. Instability is more likely to lead to degenerative changes. Osteoarthritic changes are not likely to be prevented by surgical reapproximation of fragments because the impaction forces that produce the fracture often create irreversible cartilage damage at the time of the initial insult. Radiologically diagnosed osteoarthritic changes are not necessarily associated with clinical symptoms. The literature may not support the current enthusiasm for the surgical approach in the care of fractures resulting from lower‐energy injuries. Long‐term results will probably demonstrate that in lower‐energy produced fractures, the nonsurgical treatment gives equal, if not better clinical results. Permanent angular deformities following closed or surgical treatment, if held within a few degrees, do not create impairment of function and from the aesthetic point of view are often more acceptable than surgical scars. The vast majority of Colles fractures can be successfully and inexpensively treated by nonsurgical means that call for stabilization of the forearm in a relaxed attitude of supination.

ISSN:0885-9698    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Summary:External fixation is a useful tool in the management of some of the more complex fractures of the distal radius. Nonetheless, it has been associated with complications. When used in the right conditions with adherence to a strict technical and surgical principles, problems can be avoided and successful outcomes can be obtained. Expeience in use of the technique learned through “both success and complications” has provided a foundation for this review. There are various ways that external fixation can be applied and combined with additional techniques of internal fixation and bone grafting in order to provide a safe system of treatment while minimizing complications and optimizing outcomes.

ISSN:0885-9698    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Summary:Multiple techniques are available for the treatment of distal radius fractures. Intrafocal (Kapandji) pinning is one available technique. The technique is based on placement of wires into the fracture site, pivoting the wires distally about 45°, then proximal advancement of the pins through cortical bone. Pins must be carefully placed between the dorsal wrist compartments. This technique may permit early mobilization of the patient's wrist. A literature review has been provided to allow the reader to consider previous authors' results.

ISSN:0885-9698    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Summary:The treatment of distal radius fractures is evolving. Internal fixation is becoming more popular as surgical techniques and implants improve. The dorsally displaced unstable distal radius fracture is a common injury. Because the fracture is unstable, cast treatment alone leads to fracture collapse and functional problems. External fixation can maintain fracture length and alignment better than a cast alone, but is associated with frequent complications. Dorsal plating and bone grafting allow accurate reduction and early motion. This is a common orthopedic practice for other intraarticular fractures. It can be applied safely and predictably to the distal radius as well.

ISSN:0885-9698    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Summary:In recent years, it has become more popular to treat fractures of the distal radius with internal plate fixation. The advantages of dorsal plating for buttressing dorsally displaced fractures and allowing direct manipulation and control of articular fragments have long been recognized. Renewed interest in dorsal plating is the result of the development of lower profile implants for the dorsal surface of the distal radius. While these dorsal plates have facilitated the treatment of many complex traumatic wrist injuries, there is still a risk of tendon irritation and rupture. Plate fixation of the volar surface of the distal radius is the most predictable treatment of unstable volar bending fractures (Smith's fractures) and volar articular marginal shearing fractures (Barton's fractures). On occasion, an articular fracture is so complex that plate fixation of both the volar and dorsal surfaces of the distal radius may be necessary to control all of the fragments.

ISSN:0885-9698    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Summary:Open reduction and internal fixation of displaced Colles fractures traditionally depend on screws, plates, and pins. Screws and plates can provide rigid fixation but frequently the plate will not exactly fit the fracture pattern and the screws can fragment the small dorsal cortical pieces of bone. Pins (K‐wires) are small enough to not fragment the bone, but they do not provide rigid fixation and can interfere with gliding of the overlying tendons. The TriMed Wrist Fixation System obviates these problems by securing the distal fragments with a combination of wire forms and pin plates. The wire forms and pin plates stabilize the distal fragments, but are secured proximally in the stronger intact metaphyseal/diaphyseal bone.

ISSN:0885-9698    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Summary:A distal radioulnar joint injury is a common cause of persistent symptoms following treatment of a distal radius fracture, however its diagnosis can be difficult in the acute setting. Early diagnosis of distal radioulnar joint disruption and primary repair of the soft tissues and bone optimizes the prospect to achieve a stable, pain‐free, functional joint. Bony repair may be required for fractures of the ulnar styloid, sigmoid notch, and ulnar head. Tears of the distal radioulnar ligaments from the ulnar head are common. Repair of the ligaments can be accomplished by an open or arthroscopically assisted technique.

ISSN:0885-9698    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Summary:Suboptimal treatment of distal radius fractures may lead to malunion with the patient experiencing pain, deformity, and loss of motion. With careful properative planning, operative osteotomy may correct the deformity near to its pre‐injury alignment. The use of plate fixation and iliac crest corticocancellous bone graft provides for a stable construct allowing early rehabilitation.

ISSN:0885-9698    

出版商:OVID    

年代:2000

数据来源: OVID