| Colles fracture belongs to the types of distal radius fractures and shift to the dorsal.In 1814,Abraham Colles described this type of fracture in detail, since then this type fracture known as Colles fracture.Most of it caused by indirect violence,commonly found in fall while the elbow stretched and the foream pronation,wrist dorsiflexion,with hands palm down and injured. Then Wrist begin to pain and rapidly swelling,often spread to the below 1/3 of the connection which is the back of the hand and foream.If the fracture displacement serious,It may be fork-like deformity. This will affect fingers activities and the rotation of wrist and forearm.It can be touched tenderness and bone fricative at distal radius.By careful examination can be founed abnormal relation at the ulnar and radial styloid process.Such as the radial styloid process at the same level with the ulnar styloid process or the ulnar styloid process distal to the more prominnent then the radial styloid process.X-ray often show the typical dislocation:distal radial fracture fragment translocation to the dorsal; distal radial fracture fragment translocation to the radial side;fracture site angled to the palmar;radial shortened;the dorsal bones of fracture site embedded or comminuted fractur;block of distal radius fracture supinated.The typical fork-like deformity composed by these dislocation make palmar angle and ulnar deviation smaller or negative angle.X-ray commonly associated with ulnar styloid fractures,and the fracture ulnar styloid have different degrees separation,the severe cases translocation to the radial;if there is no ulnar styloid fractures and the far off-side radius translocation significantly to the radial,it means that the triangular fibrocartilage disc have teared.There are many ways to treatment colles fractures,in fact most treatment can make patients satisfied by manipulation and cast immobilization or splintage.currentlly,experts have different opinions on the non-surgical treatment of Colles fractures, the specific methods include the use of Cotton-Lorder position,nertral position or dorsiflexion-bit fixed.The clinical treatment effect of Colles fractures is not only related to the therapy but also related to the degrees of fracture injury and other factors,but people pay less attention to it. According to Frykman classification method this subject divided Colles fracture into different degree of injury,and patients with the same degree of injury receive different fixed position treament after manipulation.Then evaluate of the efficacy and sum up the law,to provide reference for clinical treament.1 Objective1.1 The X-ray parameters (including dorsal angulation, radial angle, radial shortening and distal radioulnar joint space) of wrist were measured,to provide a basis for damage degree of Colles fracture.1.2 To Explore the classification system and it's implications of Colles fracture.1.3 To evaluate the effect of Colles fracture with different kinds of external fixation, and to provide reference for treatment.2 Methods2.1 The X-ray observation:The X-ray parameters (including dorsal angulation, radial angle, radial shortening and distal radioulnar joint space) of wrist were measured and classified according to the Frykman classification system in 128 Colles fracture patients.2.2 The different kinds of external fixation180 cases of Colles fracture were followed up and 33 were classified asⅠ,33 asⅡ,24 asⅢ,21 asⅣ,21 asⅤ,21 asⅥ,15 asⅦ,12 asⅧaccording to the Frykman classification system.Each type of the fractures were fixed with three kinds of external fixation,Group A:The wrist in Cotton-Lorder position fixation,Group B:The wrist in neutral position fixation,Group C:The wrist in mild dorso-extend position fixation.All patients were evaluated with Gartland and Werley scoring system for wrist function following up for 6～18 months.3 Results3.1 The X-ray observation:3.1.1 Frykman classification:(21.1%) were classified asⅠ,30 (23.4%) asⅡ,15(11.7%) asⅢ,17(13.3%) asⅣ,13(10.2%) asⅤ,12(9.4%) asⅥ,9(7.0%) asⅦ,5(3.9%)asⅧ.3.1.2 X-ray showed far off-side translocation to the dorsal or (and) the radial.The mean of palm tilting angle of 128 patients is -8.94°,and the maxinum is 8.89°,the minimum is -30.86°;Of which,the mean of palm tilting angle of typeⅢis-2.89°,which changes relatively smaller than others.The degree of palm tilting angle of typeⅠ,typeⅡandⅢaverage in -5°～10°. And type ofⅤ,Ⅵ,Ⅷaverage more than 10°.107 cases (83.6%) changed to negative angle, the type ofⅦand M with negative angle all andⅧis maximum(-20.97°);3.1.3 The mean of ulnar deviation angle is 14.54°, the maxinum is 28.21°,the minimum is 4.70°.and the mean have no significant difference among the type ofⅠ,Ⅱ,Ⅲ,Ⅳ,Ⅶ,the type ofⅤ,Ⅵ,Ⅷis relatively small, and the type ofⅥis minimum(10.74°).3.1.4 The mean of radial shortening of all classifications is 2.42mm, the max is 7.48mm,of which 86 cases (67.2%) exceeded 2mm,9 cases of typeⅠ,17 cases of typeⅡ,10 cases of typeⅢ,15 cases of typeⅣ,12 cases of typeⅤ,9cases of typeⅥ,9 cases of typeⅦ,5 cases of typeⅧ. the type ofⅦandⅧall exceeded 2mm.3.1.5 64 cases (50%) with fracture of ulnar styloid among the 128 patients,30 cases of typeⅡ,17 cases of typeⅣ,12 cases of typeⅥ,5 cases of typeⅧ. 3.2 The different kinds of external fixation3.2.1 The wrist function of A,B,C groups which is classificated in Frykman typeⅠand typeⅡTypeⅠgroup A:excellent is 5 cases,good is 5 cases, the rate of excellent and good is 90.9%.group B:excellent is 8 cases,good is 3 cases, the rate is 100%.group C: excellent is 6 cases,good is 4 cases, the rate is 90.9%. there is no significant difference among three groups(x2=2.237, P=0.692(2-sided)) in statistics.TypeⅡgroup A:excellent is 7 cases,good is 3 cases, the rate of excellent and good is 90.9%.group B:excellent is 7 cases,good is 3 cases, the rate is 90.9%.group C: excellent is 5 cases,good is 4 cases, the rate is 81.8%. there is no significant difference among three groups(x2=1.121, P=0.891(2-sided)) in statistics.3.2.2 The wrist function of A,B,C groups which is classificated in Frykman typeⅢang typeⅣTypeⅢgroup A:excellent is 3 cases,good is 2 cases, the rate of excellent and good is 62.5%.group B:excellent is 6 cases,good is 2 cases, the rate is 100%.group C:excellent is 5 cases,good is 2 cases, the rate is 87.5%. there is no significant difference among three groups (x2=4.50, P=0.343(2-sided)) in statistics.Type IV group A:excellent is 3 cases,good is 1 cases, the rate of excellent and good is 57.1%.group B:excellent is 4 cases,good is 2 cases, the rate is 85.7%.group C: excellent is 3 cases,good is 3 cases, the rate is 85.7%. there is no significant difference among three groups (x2=3.70, P=0.717(2-sided)) in statistics.3.2.3 The wrist function of A,B,C groups which is classificated in Frykman typeⅤang typeⅥTypeⅤgroup A:excellent is 1 cases,good is 1 cases, the rate of excellent and good is 28.6%.group B:excellent is 4 cases,good is 2 cases, the rate is 85.7%.group C:excellent is 4 cases,good is 1 cases, the rate is 85.7%. there is significant difference among three groups (x2=11.85, P=0.065(2-sided)) in statistics. TypeⅥgroup A:good is 1 cases, the rate of excellent and good is 28.6%.group B:excellent is 4 cases,good is 2 cases, the rate is 85.7%.group C:excellent is 3 cases,good is 2 cases, the rate is 71.4%. there is significant difference among three groups of A and B and C(x2=11.314, P=0.068(2-sided)) in statistics.3.2.4 The wrist function of A,B,C groups which is classificated in Frykman typeⅦang typeⅧThe three groups of Type VII all have lower efficacy,and there were no significant difference among these three groups of A and B and C(x=2.167 P=0.705(2-sided)).The three groups of TypeⅥall have lower efficacy,and there were no significant difference among these three groups of A and B and C(x=0.75, P=0.687(2-sided)).4. Conclusion4.1 The X-ray examination provides a basis for classification and damage degree of Colles fracture and has guidance significance on treatment.4.2①The effect of the Colles fracture on the wrist in Cotton-Lorder position or neutral position or mild dorso-extend position fixation was not differences in typeⅠand typeⅡ,all of them can get good results.Thus, in clinical treament It's the best chose for Colles fracture with non-surgical treament,and three fixed-position methods can be applied.②There is no statistically significant difference among three ways of fixed-position in typeⅢand typeⅣ.But the excellent rate of neutral position and slight dorsiflexion position is significantly higher than the excellent rate of Cotton-Lorder position.therefore,in clinical treating we recommend the neutral position or mild dorso-extend position fixation on Colles fracture of typeⅢand typeⅣ.③There is statistically significant difference among three ways of fixed-position in typeⅤand typeⅥ.This may be related to the triangular fibrocartilage injury.Colles fracture is the injury caused by forearm pronated.The ligament of the dorsal of wrist triangular fibrocartilage and the distal radioulnar often tear,even triangular fibrocartilage disc completely tear or with ulnar styloid fracture,as result, these cause the distal radioulnar joint disorder,subluxation or wholly dislocation.so the effect on the wrist of neutral position or mild dorso-extend position fixation is better than Cotton-Lorder position.④For the type ofⅦandⅧ, there is no statistically significant difference among three ways of neutral position mild dorso-extend position fixation and Cotton-Lorder positional,all of treaments were poor results. For the type ofⅦandⅧis not suitable for conservative treament because of seriously injury.so in clinical,we recommend surgery as soon as possible to recover the wrist function if the patients physical condition good. |
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