Retrospective Analysis Of The Complications Of Fractures Of Distal Radius

Objictive:The fracture of distal radius is within 3cm of the articular surface of the distalradius.Its incidence is about 17% of emergency fracture patients.Intra-articular fractures of the distal radius accounts for 5% of the forearm fractures and 25% of the distal radius fractures.It was reported in the literature,that the distal radius fractures occurred in 6～10-year-old and 60～75-year-old age phases.But in recent years,intra-articular distal radial of young adults caused by high-energy trauma have been growing seriously.Its fracture morphology and displacement of fractured ends are complex,and is easy to involve neighbouring joints.Clinical improper handling can easily lead to all kinds of complications,such as bone compartment syndrome,Volkmann's contracture,carpal tunnel syndrome,scaphoid fracture,triangular bone fractures,the dislocation of distal radioulnar joint,tendon injury,wrist nerve injury,malunion,traumatic arthritis and result in inability,deformity,shortening,stiffness,pain and limitation of activity of wrist joint.At present,domestic research reports about retrospective clinical analysis and forward-looking fracture of distal radius complications are less.the paper is to investigate incidence characteristics of the complications of the fractures of distal radius,prevention and treatment. Methods: 276 cases with fractures of distal radius who hos-pitalized in the Third Hospital of Hebei Medical University from June 2003 to September 2007 were reviewed.The average follow-up time of the patients was 13 months(6-24 months),All patients who were followed up had wrist radiology and func-tional assessment.we statisticsed and retrospectively analyzed the age of onset,injury cause,trauma characteris-tics,complications respectively.Functional assessment includes subjective part and objective part,in the light of modification of the Gartland and Werley rating score.According to subjective and objective criteria,it is divided into different functional lev-els:0 to 2 is divided into excellent,3to 8 is divided into good,9 to 14 into moderate,≥15 is divided into poor.Fracture heal-ing,function of wrist joint and follow-up X-ray comprehensivly assess of functional recovery.Fracture type refers to AO classi-fication.Fracture of the distal radius is divided into A,B,C three types.In each type,there are three groups.each group is divided into three sub-groups.There is a total of 27 such subgroups.Type A:extra-articular fractures,including type A1:isolated distal ulna fracture:type A2:fracture of the distal radius,without comminu-tion and inserting;type A3:fracture of the distal radius,with comminution and inserting.Type B:simple intra-articular frac-tures,including type B1:sagittal plane fractures of the distal ra-dius;type B2:dorsal margin fractures of the distal radius;type B3;the palmaris margin fractures of the distal radius.Type C:complex intra-articular fractures,including type Cl:intra-articular simple fractures,without metaphysic com-minution;type C2:Simple articular surface fracture with com-plex metaphysic fracture;type C3:complex articular fractures with metaphysic fracture.Result: In this cases,from June 2003 to September 2007,276 cases with fractures of the distal radius were hospitalized and treated.Of them,158 cases were followed up. In 276 cases, 181 cases were men,accounting for 65.58% and women 95 cases,accounting for 34.42%.the ratio of men and women was 1.91:1.Type A,177 cases,A1:16 cases;A2:148 cases;A3 type:13 cases.Type B:48 cases,B1:11 cases;B2:23 cases;B3:14 cases.Type C:51 cases,Cl:10 cases,C2:23 cases;C3:18 cases.The age of onset and distribution different gender of the fractures of distal radius,Vulnerating causes:traffic injuries 65 cases,crashes injury 35 cases,falling injury 135 cases,10 cases of in-jury-cutter,the other causes are 31 cases.Each patient has a clear history of trauma.The type of violence include shearing force inflexion force,pressure,avulsion force and high-speed effective force.The time from injury to the operation is 2 h-4 days,the av-erage time two days.In 276 cases,open wounds are 16 cases,simple fractures 60 cases,merger injuries (head,chest,abdomen) crinosity fractures 216 cases 77 cases had complications,and the incidence of complications was 27.90%,bone compartment syndrome 5 cases,the incidence was 1.81 percent, the dislocation of distal radioulnar joint 7 cases,the incidence was 2.53%,dislocation of wrist joint 5 cases,the inci- dence was 1.81%,dislocation of elbow joint 7 cases,the inci-dence was 2.53%,scaphoid fracture 6 cases,the incidence was 2.17%,triangular bone fracture 2 cases,the incidence was 0.72%,wrist nerve injury 14 cases,the incidence was 5.1%,traumatic arthritis 20 cases,the incidence was 7.25%,carpal tunnel syndrome 1 cases,the incidence was 0.36%, malunion of the fractures of distal radius 2 cases,the incidence was 0.72%,osteomyelitis 1 case,the incidence was 0.36%,Volkmann's contracture 1 case,the incidence was 0.36%,delayed healing 1 case,the incidence was 0.36%,pin tract infection 5 cases,the incidence was 1.81%. functional evalua-tion:excellent 33 cases,good 51 cases,moderate 63 cases,poor:11 cases.Conclusion:Through the retrospective analysis of this pa-per,we can conclude that types of fracture and extent of reduc-tion directly relates to the prognosis of distal radius fractures. At the time of fracture fixation,we should have early functional training.Therefore,in handling the fractures of distal radius,to understand all the potential complications and characteristics can contribute to the early diagnosis,timely treatment,reducing loss of function and restoring limb function to the maximum ex-tent.