| Objective:Distal radius fractures refer to fractures within 3 cm of the articular surface of the distal radius.The incidence of such fractures is approximately 1/6 that of patients with orthopedic fractures.Intra-articular fractures account for distal radius fractures.1/4.The high rate of wrist joint activity and daily functional requirements for wrist joints may lead to stiff wrist joints and long-term chronic pain.The patient’s hand function may also be seriously affected.In order to achieve anatomical reconstruction and stabilization of distal radius fractures,clinicians often use open reduction and internal fixation to treat intra-articular fractures.However,the current standard of clinical anatomy reconstruction focuses on ulnar angle,palm angle,and tibia height.In the X-ray film on the side,more palm pitch angle as the standard.The measurements of the palm dip angle were reported differently from each other.Charles and Goldfarb et al.measured that the palm tilt angle of 2°-20°was normal and the average was 11°.Wang Qihua et al measured the 205 adult jaw bones in Guangdong Province.The palm tilt angle was(9.4±2.2)°to the left and(10.7±2.2)°to the right.At present,most people think that the normal range of palm angle is 10°-15°.Therefore,due to the large variation of the palm inclination angle,although the palm inclination angle is sometimes satisfactory,and the articular surface is poorly reset,wrist joint dysfunction will still be left.At present,there is no specific standard for the reduction of the wrist face,which is mostly judged by the surgeon’s intraoperative observation.The purpose of this study is to evaluate the effect of the reduction of the articular surface on the flexion and extension of the wrist joint by measuring the distance between the depression of the articular surface of the distal radius of the lateral radiograph.Methods:A total of 56 patients with closed unilateral intra-articular distal radius fractures who were diagnosed at the First Central Hospital of Baoding City from September 2015 to September 2016 were selected as the study subjects.After admission,they were all descended from the same group of medical teams.End fracture open reduction and locking compression plate fixation.The patient was photographed with a standard X-ray radiograph of the wrist at the time of surgery,2,6,12 months after the operation(the X-rays of the wrists were taken at the latest follow-up),and the palm angle,ulnar angle,and tibia height were measured.And the distance of the sagittal articular surface of the distal humerus.The angles of wrist flexion and extension were reviewed and measured at 2,6,and 12 months after surgery.Inclusion criteria: 1.Intra-articular fractures of the distal radius caused by trauma 2.All patients were closed fractures 3.All patients were treated with open reduction and internal fixation.4.All patients were unilateral fractures.Exclusion criteria: 1.Exclude previous history of upper extremity lesions and injuries 2.Exclude the incomplete closure of osteophytes.3.Exclude patients with congenital malformations and degenerative wrist joints.4.Exclusion of upper limb disorders caused by cerebrovascular disease.5.Exclude wrist movement disorders caused by nerve lesions.Results:Fifty-six patients were not lost and the follow-up time was 12 months.The palm angle,ulnar angle,tibia height,and the distance between the sagittal articular surface of the distal humerus were measured at the time of immediate postoperative,2 months,6 months,and 12 months.The palm angles at the four postoperative days were 13.2±4.5°,12.8±3.9°,12.5±4.2°,and 11.9±4.1°,respectively;the ulnar deviation angles were 22.1±3.2°,21.8±3.3°,and 21.4±3.9°,20.9±3.4°,respectively;tibial heights were 12.9±2.2mm,12.6±2.3mm,12.4±2.5mm,12.3±2.6mm;articular surface depressions were 3.9 ± 0.7 mm,3.8 ± 0.8 mm,3.7 ± 0.7,3.6 ± 0.8 mm respectively.The results showed that there was no significant difference in the distances of palm inclination,ulnar angle,sacral height,and sagittal articular surface depression between the three follow-ups and the immediate postoperative(P>0.05),and the difference was not statistically significant.The average palmar flexion angle was 48.6±4.8°at 2 months after operation,63.7±6.2°at 6 months,65.3±7.7°at 12 months,The average palmar extension angle was 31.8 ±5.2°at 2 months.,averaged 52.2±8.7°at 6 months and averaged 55.1±14.1°at 12 months.The t-test was performed at the palmar flexion angle and back extension angle at 2 months and 6 months,respectively.The p-values were all less than 0.05.The t-tests were performed at 6 months and 12 months,respectively,and the p-values were all greater than 0.05.It indicated that proper exercise within 6 months after operation was beneficial to the recovery of wrist flexion and extension.After more than 6 months,the change of wrist flexion and extension activity was not statistically significant.The distances and the flexion and extension angles of the sacroiliac joint surface at the final follow-up were smaller than those of the contralateral sacroiliac joint.The smaller the difference between the sagittal distance and the contralateral sacroiliac joint surface was,the smaller the angle of wrist flexion and extension activity was lost.Positive correlation.Conclusion:In the case of intra-articular fracture of the distal humerus,the flexion and extension activities of the wrist gradually recovered with active and passive exercise within the first 6 months.After 6 months,the wrist flexion and extension function had no significant changes.The comparison of the measurement of the distance between the concave surface of the distal tibial articular surface shows that the reduction of the articular surface has a significant effect on the recovery of the wrist flexion and extension.The closer the distance between the concave surface of the distal tibial articular surface is to the healthy side,the wrist flexion and extension.The better the recovery of the function. |
PDF Full Text Request