OBJECTIVE: To investigate the efficacy of a repositioned external fixator in the treatment of unstable fractures of the distal radius.
METHODS: Using closed reduction, 45 cases of unstable fractures of the distal radius were treated with a repositioning external fixator, 8 men and 40 women, aged 20-75 years, mean 61 years. The fractures were classified according to AO, including 18 cases of type A3, 8 cases of type B2, 10 cases of type C1, 6 cases of type C2, and 3 cases of type C3.
RESULTS: Forty-five patients received a follow-up of 6-15 months with a mean of 11.2 months. According to the Batra wrist score standard, the anatomical score was 87.78 on average, of which 25 cases were excellent, 15 cases were good, 2 cases were acceptable, and 3 cases were poor, with an excellent rate of 88.89%; the functional score was 95.23 on average, of which 45 cases were excellent, with an excellent rate of 100%.
Conclusion: The treatment of unstable fracture of distal radius with trans-replacement external fixator can achieve satisfactory clinical efficacy and is worth promoting.
The distal radius fracture refers to the fracture within 75px from the articular surface of the distal radius, among which the distal radius unstable fracture has the greatest influence on the long-term outcome. However, due to muscle contraction and loss of local stability of the fracture end, it is sometimes difficult to maintain the position after repositioning, especially the length of the radius, by splinting or plastering alone, and shortening and re-displacement of the fracture end can easily occur. The method of internal fixation of the plate has the shortcomings of large damage, high cost, many complications and unsatisfactory efficacy. Therefore, how to standardize the treatment of distal unstable radius fracture and make it have the characteristics and efficacy advantages of TCM is a difficult problem in front of us. In this paper, we analyze the advantages and shortcomings of the treatment by following up the patients treated with the repositioned external fixator for distal unstable radius fracture, so as to standardize the use of the repositioned external fixator and form a systematic, standardized, and biologic fixation system that has the characteristics of TCM treatment and meets the requirements of modern We analyzed the advantages and shortcomings of this therapy, so as to standardize the use of the repositioned external fixator and form a systematic, standardized and safe fracture therapy with Chinese medical treatment characteristics and meeting the requirements of modern biological fixation.
1. Data and methods
1.1 Clinical data Forty-five patients with unstable fractures of the distal radius treated with a repositioned external fixator had complete data and were followed up. All fractures were closed fractures caused by falling on their own and holding their hands on the ground. According to the AO classification, there were 18 cases of type A3, 8 cases of type B2, 10 cases of type C1, 6 cases of type C2, and 3 cases of type C3.
1.2 Treatment 45 patients were treated with a repositioning external fixator under anesthesia in the operating room from 1-72 hours (mean 48.8 hours) after the injury. The overall repositioning was first performed by manipulation, and after disinfection and spreading of towels, the proximal pins of the metacarpal, ulnar hawk’s-beak, and distal radius fractures were threaded and external fixators were installed, respectively. According to the fracture condition, instrumented repositioning and with local repositioning by manipulation were performed.
1.3 Observation indexes and methods The specific indexes for functional evaluation were: preoperative and postoperative wrist mobility, including palmar flexion, dorsiflexion, radial deviation, ulnar deviation, anterior rotation, posterior rotation and grip strength; the specific indexes for anatomical evaluation were: preoperative and postoperative X-ray palmar tilt angle, ulnar deviation angle and radial shortening.
1.4 Efficacy evaluation criteria of distal radius instability fracture
Batra wrist score criteria were used, and homogeneous subjects were studied using the group’s own pre-post paired study, and the functional and anatomical scores were calculated based on the results of the preoperative and postoperative measurement indexes, and the excellent rate of the group’s cases was summarized.
1.5 Statistical processing Statistical software SPSS (V 13.0) was applied for statistical processing. All measurement data were analyzed descriptively and expressed as mean ± standard deviation (). The t-test was used for the measurement data, and a P value less than or equal to 0.05 would be considered statistically significant for the difference tested.
2. Results
2.1 Batra score results
Forty-five patients in this group received 6-15 months of follow-up with a mean of 11.2 months. Batra score criteria were used to evaluate the efficacy of distal unstable radius fractures. The average anatomical score was 87.78, including 25 excellent, 15 good, 2 acceptable and 3 poor, with an excellent rate of 88.89%; the average functional score was 95.23, including 45 excellent cases, with an excellent rate of 100%. There was one case of inflammatory reaction of the needle tract.
2.2 Comparison of preoperative and postoperative imaging aspects
Pre-operative and post-operative imaging comparisons of patients with unstable fractures of the distal radius treated with trans-replacement external fixators were performed by t-test. The P value of each measurement index was less than 0.01, and the difference was statistically significant, indicating that the three postoperative indexes were better than the preoperative indexes after treatment with the resetting fixator.
3. Discussion
3.1 Advantages of the resetting external fixator
The treatment of distal radius unstable fracture by repositioning external fixator has its unique advantages. The external fixator is easy to pierce the needle, less traumatic, reducing the surgical trauma of the patient, leaving no scar, closing the needle piercing process, almost no bleeding, and the old, sick and disabled people and those who do not want to leave surgical scars can bear this kind of surgery, and it is elastic fixation, allowing micro-movement between the fracture ends without cutting and stripping the periosteum, thus greatly protecting the This greatly protects the blood flow of the fracture end and facilitates fracture healing. In addition, the external fixator provides continuous traction in the treatment of unstable fractures of the distal radius], which separates the fracture end by increasing traction. The purpose of this process is to rehabilitate the rotation and lateral displacement on this basis, and then to achieve the “separation and compounding. In this way, the fracture end is in a relatively static state under the joint action of the contraction force of the muscle group, the traction force of the telescopic rod, and the binding force of the kerf pin.
3.2 Mechanism of repositioning external fixator
By generating axial tension through the telescopic rod, it exerts a stretching and bracing force on the joint, increases the joint gap, reduces the pressure on the joint surface, corrects the shortening displacement, facilitates the reset and healing of the collapsed fracture of the joint surface, and ensures the early grinding of the joint, which is conducive to promoting the recovery of the joint surface and preventing the occurrence of traumatic arthritis. Under the guidance of Chinese medicine orthopedic theory, such as “to close first, separate and compound”, “tendon bind bone” and “make instrument to correct”, the combined repositioning characteristics of manipulation and instrumentation are highlighted. The external fixation of the closed needle repositioning apparatus plays the role of traction and tension on the fracture, and the soft tissue tension around the fracture forms a “muscle splint”, which restrains the fracture fragment, thus realizing the device to correct the fracture, and the fracture end can be fully moistened by qi and blood. Continuous traction can also stimulate the growth of bone. This is the theory of bone formation by traction. Professor I1izarov, a famous Russian orthopedic surgeon, after years of efforts, creatively designed the I1izarov external fixator for the treatment of bone discontinuity and limb shortening deformity, and based on this, he proposed the theory of distraction osteogenesis. In the slow and continuous distraction, cell proliferation and biosynthesis functions are stimulated and tissue metabolism becomes active. As the new bone lengthens, the blood vessels, nerves, muscles, skin, mucosa, ligaments, cartilage and periosteum attached to it are expanded accordingly.