Minimally invasive treatment for distal radial fracture and dislocation of type IV based on Fernandez classification / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the effects of external fixation combined with minimally invasive internal fixation for the treatment of distal radial fracture and dislocation of type IV based on Fernandez classification.</p><p><b>METHODS</b>From January 2007 to October 2012,19 patients with the distal radius fracture and dislocation of type IV according to Fernandez classification were reviewed. There were 14 males and 5 females,ranging in age from 22 to 42 years old,with an average of 36.5 years old. All the patients were treated with minimally invasive reduction, and external fixation with finite internal fixation. The K-wire was used to fix radiolunate articular surface for correcting the instability of dorsal and volar intercalated segment. The radiolunate angle, scapholunate angle, and the length of the radial shorting were measured by the standard X-ray. Gartland and Werley evaluation system was used to evaluate recovery of function.</p><p><b>RESULTS</b>No complications such as injury of blood vessels and radial nerves and pin track infections occurred. After operation, the radiolunate angle, scapholunate angle and the length of the radial shorting time were (9.5 +/- 3.3) degrees, (51.3 +/- 11.2) degrees and (11.2 +/- 1.8) mm by the standard X-ray. On the 3rd month after operation, GW score was 3.02 +/- 3.05. There was no re-displacement and subluxation occurred during the follow-up period. Good functional recovery were improved wrist function significantly.</p><p><b>CONCLUSION</b>External fixation combined with minimally invasive internal fixation can treat distal radial fracture and dislocation of type IV based on Fernandez classification. Wrist joint stability depends on the structure of the bone and ligament around wrist joint. Emphasis on the diagnosis and treatment of carpal instability, and postoperative functional rehabilitation can improve wrist function.</p>

Effect on wrist joint stability following distal radial fractures / 中华外科杂志

<p><b>OBJECTIVES</b>To investigate the influence of wrist joint stability of patients with diversified fracture of the distal radius, and to find out the difference of the clinical effect between the patients with surgical treatment and non-surgical treatment.</p><p><b>METHODS</b>From January 1999 to September 2006 a total of 200 cases with the fracture of the distal radius were reviewed according to the AO classification, the radiolunate angle, scapholunate angle, palmar tilt angle and the length of the radial shorting and step-off of the articular surface were measured by the standard X-ray. Gartland and Werley as modified by Sarmiento evaluation system was used, and the results were statistically analyzed.</p><p><b>RESULTS</b>The average follow-up period was 5 years and 2 months. The follow-ups revealed 5 types of carpal instability: scapholunate dissociation, volar intercalated segment instability, dorsal intercalated segment instability and palmar or dorsal shift of the carpus. Functional results were excellent and good in 78% of the total patients. The increasing of the length of the radial shorting and step-off of the articular surface was found to be associated with greater risk of carpal instability.</p><p><b>CONCLUSIONS</b>Based on the results of the study, wrist articular surface and radial shortening and palmar tilt angle should be considered as the most important factors of the healing effect after the fracture of the distal radius. Wrist joint stability depends on the structure of the bone and ligament around wrist joint. Carpal instability wound leads to significantly effect on the wrist. And surgery was necessary to severe intra-articular fracture of the distal radius.</p>