| ObjectivesThe present study was aimed at providing reliable basis for treatment of distal radial fractures with small splints by both clinical and experimental investigations. Firstly, through the study of clinical trials in healthy volunteers under the guidance of expert group, we measured and analyzed the decay time of binding force, to further quantify and standardize the treatment of distal radial fracture by small splints, which helps initially determine the effective range of pressure to fix the fracture. Then, randomized controlled clinical study was performed to verify the clinical efficacy of the quantitative binding force on the splints for the treatment of distal radial fracture (Straight Type).MethodsExperimental research:10 healthy volunteers were selected, and simulated distal radial fracture (Straight Type) line splintage. Under the guidance of the expert group, we measured the force provided by splints under different conditions and how it decayed over time. Then by statistical analysis, we determined the appropriate range of pressure to maintain the effective fix of fracture, set the treatment to a quantified and standardized model.clinical research:66 eligible patients of distal radial fracture (Straight Type) from Guangdong Provincial Hospital of Chinese Medicine were included, grouped as Experimental Group and Controlled Group randomly, and followed up for 3 months. At 12,30,60,90 days, the patients had X-ray examination of the injured forearm. And anatomy of Grading, Dienst functional assessment criteria were applied to assess the treatment effect at 1,2,3 months after reset. These data, as well as safety indicators, including pressure sores, fingers feeling, and blood supply were statistically analyzed.ResultsExperimental research:different experts have completed a small splint and measured the pressure. Pressures between groups were statistically significant (P<0.05). The measured pressures between static group (no functional exercise) and dynamic group (functional exercise) were statistically significant (P<0.05). The pressure of the dynamic group decays earlier than that of static group. At the midterm the pressure of the dynamic group is less than the other group. At the advanced stage the pressure of the two groups were similar. We also found that the position of limbs, swelling of limbs also effect the pressure. According to the study, the initial pressure to determine the value of the fixed tie the effective range of 600±100g, based on the pressure decay, suggesting that patients require daily dressing changes early. Initially set the quantization scheme.Clinical research:Basic characteristics of gender, age, anatomical evaluation criteria score, Dienst functional evaluation criteria score, were balanced between the two groups of measured and controlled groups.1,2,3 months after treatment, anatomical assessment of the two groups was significantly different (P<0.01, P<0.01, P<0.01), with better improvement achieved by measured group than the controlled group. Efficacy scores between groups were significantly different (P<0.05, P<0.01, P<0.01), measured group has superior clinical effect to controlled group.Conclusions1. The majority of distal radical fractures through the gimmick reset can be well reseted, restore relatively normal anatomy, and this anatomical relationship in the fracture healing process can be maintained, whether the shift will happen again, that can affect the efficacy.2. In addition to the factors that affect the stability of the fracture energy and the injured degree of metaphyseal comminution, bone quality, through clinical research, we believe that the effectiveness of the fixed factors are also important, especially for unstable fractures more meaningful. And fixed by the binding force of the impact of cable ties, cable ties binding force of the impact of factors.Such as, the material mechanics factors with karzai, changes in body weeks diameter, physical activity (Including functional training, etc.), and location of body.3. Quantitative treatment of small splints is necessary. From the materials perspective, local external splint fixation system unstable, with a clear viscoelastic properties and anisotropy. Will fracture a variety of factors cause the uncertainty of treatment efficacy? By maintaining a small splint to quantify the effective fixed, and then shift to reduce the incidence of fractures, improve the efficacy; for unstable fractures, can also better maintain the reset position; while reducing complications.4. Dienst anatomical assessment and functional assessment standard evaluation criteria score is related to, but not simple correlation, functional improvement in addition to associated with the reduction, but also relevant in the case of soft tissue, also reflects the traditional Chinese medicine "bones and muscles are both important" concept.5. With expert guidance, we quantified the following views:elderly patients to maintain an effective constant pressure of about 600±100g, the initial lashing pressure should be around 600±50g; fixed the forearm in neutral position is appropriate; early to be adjusted daily cable ties, fracture healing after the initial adjustment the next day; line functional exercise. Clinical studies to quantify the program could improve the outcome.
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