Background: Fracture of distal radius with involvement of the ulnar styloid process is a common clinical problem. It can be treated conservatively, usually involving wrist immobilization in plaster cast or surgically....Background: Fracture of distal radius with involvement of the ulnar styloid process is a common clinical problem. It can be treated conservatively, usually involving wrist immobilization in plaster cast or surgically. A key method of surgical fixation is external fixation by distractor. Distractor can be applied either only on the radial side or on both ulnar and radial sides. Materials and Methods: A prospective randomized and comparative study of 1 year duration was conducted on 32 patients admitted in the Department of Orthopaedics of BSMC & H in the age group of 20 to 75 years old with AO types B and C distal radius fracture along with involvement of the ulnar styloid process. The parameters studied were restoration of radial length, restoration of radial angle, intracarpal step-off and palmar tilt which were statistically evaluated and Fisher’s exact test was performed. The two tailed P-value was calculated and both the groups were statistically compared. Results: In our study, 37.5% patients in Group A and 81.25% in Group B had a radial difference Table 1, Chart 1). 43.75% patients in Group A and 87.5% in Group B had radial angle Table 2, Chart 2). 31.25% in Group A and 75% had intra carpal step off Table 3, Chart 3). 62.5% had an abnormal palmar tilt in Group A while only 6.25% had an abnormal palmar tilt in Group B which is extremely statistically significant. On an average, 2 mm of distraction was required in 75% patients of Group A while only 30% patients in Group B required distraction (Table 4, Chart 4). Conclusion: In our study, the radial difference, radial angle, intra carpal step off and palmar tilt returned significantly to normal in the patients treated with distractor on radial side only when compared with distractor application on both radial and ulnar sides for distal radius fracture with ulnar styloid process involvement. Also post-operative distraction required under image intensifier was higher in the group treated with distractor on either side than those with distractor only on radial side.展开更多
文摘目的：探讨改良的背侧手术切口入路在治疗早期（21～35 d）桡骨远端陈旧性骨折的临床效果。方法对36例（40侧）早期桡骨远端陈旧性骨折患者行改良背侧手术切口入路治疗。分析其手术时间、术后复位X线摄片评价、术后并发症、骨折愈合时间及肢体肿胀消肿时间的情况，按Gartland and werley功能评分标准对患者腕关节功能恢复情况进行评价。结果36例（40侧）患者手术时间为65～90 min，平均75 min。术后复查X-ray骨折端对位、对线，桡骨远端长度及掌倾角恢复良好，骨折端稳定，无切口感染，无桡神经皮支或正中神经损伤及骨筋膜室综合征。患侧肿胀消退时间为术后5～10 d，平均7.3 d；骨折愈合时间为术后2.8～4.3个月，平均3.5个月。所有病例均获3～12个月的随访，按Gartland and werley功能评定，优26侧，良9侧，可3侧，差2侧，优良率为87.5%。结论通过改良背侧手术切口入路对早期桡骨远端陈旧性骨折患者进行手术治疗，能取得满意的效果。
文摘Background: Fracture of distal radius with involvement of the ulnar styloid process is a common clinical problem. It can be treated conservatively, usually involving wrist immobilization in plaster cast or surgically. A key method of surgical fixation is external fixation by distractor. Distractor can be applied either only on the radial side or on both ulnar and radial sides. Materials and Methods: A prospective randomized and comparative study of 1 year duration was conducted on 32 patients admitted in the Department of Orthopaedics of BSMC & H in the age group of 20 to 75 years old with AO types B and C distal radius fracture along with involvement of the ulnar styloid process. The parameters studied were restoration of radial length, restoration of radial angle, intracarpal step-off and palmar tilt which were statistically evaluated and Fisher’s exact test was performed. The two tailed P-value was calculated and both the groups were statistically compared. Results: In our study, 37.5% patients in Group A and 81.25% in Group B had a radial difference Table 1, Chart 1). 43.75% patients in Group A and 87.5% in Group B had radial angle Table 2, Chart 2). 31.25% in Group A and 75% had intra carpal step off Table 3, Chart 3). 62.5% had an abnormal palmar tilt in Group A while only 6.25% had an abnormal palmar tilt in Group B which is extremely statistically significant. On an average, 2 mm of distraction was required in 75% patients of Group A while only 30% patients in Group B required distraction (Table 4, Chart 4). Conclusion: In our study, the radial difference, radial angle, intra carpal step off and palmar tilt returned significantly to normal in the patients treated with distractor on radial side only when compared with distractor application on both radial and ulnar sides for distal radius fracture with ulnar styloid process involvement. Also post-operative distraction required under image intensifier was higher in the group treated with distractor on either side than those with distractor only on radial side.
