| Objective:By observing the three different treatment methods among the manual reduction end bending bamboo splint fixation system, open reduction of volar bone plate internal fixation and closed reduction in external fixator to treat the elderly of type C fractures of the distal part of the radius of curative effect and complications, discuss the best ways in treatment of the elderly of type C fractures of the distal part of the radius. Summarize the teacher manual reduction end bending bamboo splint fixation system to treat the elderly of type C fractures of the distal part of the radius of clinical experience.Methods:80 patients were from the orthopedics of the affiliated hospital of shandong university of TCM and the second affiliated hospital of shandong university of TCM from August 2013 to August 2014,In which there were 29 male and 51 female cases, the yongest one was 60 years old and the oldest was 90 among these patients, the mean ages was 71.2±6.75 yesrs old. All these patients went to hostipal within 8 hour after fracture and were all closed fractures. The damage reasons were:58 cases by hurt,16 cases in traffic accident injury,6 cases by heavy injures.They were all unilateral damage, in which 28 cases on the left side and 52 cases on the right side.accompanying intertrochanteric fractures in 4 cases,3 cases of femoral neck fracture,1 cases of patellar fracture and 1 cases of metacarpal fracture. There were no statistical differences in the proportion of gender,injury causes, complications and the type of fracture among these three groups. Three groups all through the outpatient care follow-up,80 patients were followed up for 3 to 24 months, an average of 15 months.Patients respectively on the postoperative day,1 month,3 months,6 months,12 months review and positive lateral X ray and observation of fracture healing, manual reduction bending type splint external fixation group for adjusting the needs of the external fixation, also need to be fixed after 3 days,1 week,2 weeks,4 weeks to check the X-ray, recorded the imaging findings of fracture, checked the soft tissue swelling and the function of wrist joint activities and scored Cooney wrist joint function after 3 and 12 months in surgery. Compared the three groups of fracture healing time and postoperative imaging findings in 12 months and their complications.Results:healing time of fracture by the manual reduction end bending bamboo splint fixation system was 11.07 ± 0.715 weeks,11.06 ± 0.227 weeks by open reduction of volar bone plate internal fixation and 11.09 ± 0.461 weeks by closed reduction in external fixator. There were no statistical differences in healing time of fracture among these three groups(P>0.05). The image findings after 12 months by manual reduction end bending bamboo splint fixation system in treatment group palmar tilt10.4 ± 2.0°,radial inclination19.9 ± 4.6°,radial length9.9 ± 1.3 mm; palmar tilt 10.6 ± 2.7°, radial inclination 20.8 ± 2.3°, radial length10.4 ± 1.4 mm by open reduction of volar bone plate internal fixation; palmar tilt 10.8±2.3°,radial inclination 19.9 ± 4.6°, radial length10.1± 1.1 mm by closed reduction in external fixator. There were no statistical difference in terms of palm Angle, foot Angle, radial length among the three groups (P> 0.05). Three groups of postoperative 3 months Cooney wrist joint function score comparison, manual reduction splint external fixation system in treatment group was 27.5%, open reduction and anatomy of the volar locking plate fixation group was 60%, total closed reduction and external fixator group was 20%, Three groups of postoperative 3 months Cooney wrist joint function score comparison open reduction and internal fixation with locking plate group 3 months after wrist function is better than the other two groups (P< 0.05). Three groups of postoperative 12 months Cooney wrist joint function score comparison, manual reduction splint external fixation system in treatment group was 82.5%, open reduction and anatomy of the volar locking plate fixation group was 80%, total closed reduction and external fixator group was 75%, There were no statistical difference in terms of Cooney wrist joint function score comparison among the three groups (P>0.05). Three groups of complications were no statistical difference (P>0.05).Conclusion:the curative effect were affirmative to treat the elderly of type C fractures of the distal part of the radius by these three different kind of ways. Closed reduction could shorten fracture healing time. Open reduction volar anatomical bone plate internal fixation could obtain better imaging findings and recover function of wrist joint earlier. Three different treatments all had corresponding complications. Different treatment could obtain satisfactory long-term wrist joint function. manual reduction end bending bamboo splint external fixation standardization system to treat the elderly of type C fractures of the distal part of the radius must pay attention to every link of the process of treatment, normalized using the means of palasy, and reset accuracy, for the first time at the end of bend type bamboo splint fixed neutral position was the prerequisite of curative effect; observed the illness Closely, avoided complications, maintained better end reset;Wrist and hand function exercise was the key to restore joint function;The third phase of drug use was strictly to eliminate swelling, restoring function of the main auxiliary treatment. Wrist joint function recovery was the final goal of treatment in the elderly of type C fractures of the distal part of the radius. manual reduction end bending bamboo splint external fixation standardization system the curative effect of treatment of the elderly of type C fractures of the distal part of the radius, There was no significant difference among the wrist joint function recovery, imaging manifestations and complications in postoperative of 12 months with open reduction and internal fixation group and closed reduction and external fixator fixed group.This method did not need hospital treatment, simple operation, little pain and low treatment cost, It was more easily accepted by patients and the best choice of treatment for the elderly was of type C fractures of the distal part of the radius. |
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