| ObjectivesProspective non-randomized observation of the international classifica-tion Cooney Ⅱ or Cooney Ⅲ distal radius fracture.By comparing the wrist function regeneration evaluation8months after distal radius fracture, whet-her closed manipulative reduction and small splints or open reduction and Volar approach plate and screw internal fixation surgery was much better to be chosen to treat Cooney Ⅱ or Cooney Ⅲ distal radius fracture.MethodsThere were62patients in Guangdong hospital of TCM into line with the standard Cooney Ⅱ or Cooney Ⅲ distal radius fracture from December2010to July2011were observed. In accordance with the collection of the patients, who were taken closed manipulative reduction and manipulate fixation at the Emergency Department in Guangdong hospital of TCM as the observer group, while the others which were treated by open reduction and Volar approach plate and screw fixation surgery at Inpatient Department were regarded as the control group.1. According to the international classification Cooney standard, the pa-tients were divided into Cooney Ⅱ or Cooney Ⅲ, asked to return visit ho-spital after resent in3days,1week,2weeks,4weeks and8months.2. In this research, X-ray and huahai workstation software were used to measure and record during treatment, particular in the certain point of time of distal radius fracture before the reset, after the reset,1week after the reset and the clinical heal ing time. By measuring bone of Orthopedics im-aging parameters, such as the foot angle, Palm dip and the height of radius during treatment, they could be used to analyze the reduction of fracture shift after resent, loss of reduction and healing.3. Record two groups clinical time and the adverse events and analyz whether the two different treatment affected the fracture healing or nor.4. Patients observed who were followed-up at least8months in this res-earch. According to Gartland and Werlkey wrist function evaluation standard, all patients in the two groups were given a mark in each part of the standard, such as residual deformity, subjective evaluation, objective evaluation and complications. And each patient would be recorded and calculated a total sco-re finally. In accordance with the General0～2scores was regarded as exce-llent,3-8scores good,9～20scores fair and more than21scores poor. Then the excellent rates of wrist function could be calculated.5. In this research, all the data could be measured twice in order to reduce errors. And all the clinical information which was collected into the databases to draw a conclusion by the appropriate methods for statistical analysis on the SPSS18.0software.Results62cases distal radius fractures which were followed-up well at least8months were brought into this research. No patient with nonunion was occurred. There was no different significance in the healing time and adverse events between two groups (P>0.05). During the treatment, the result in which X-rays was scored to analyze the fracture healing was no different significantly at the certain point of time of distal radius fracture before the reset, after the reset,1week after the reset between the two groups (P>0.05). However, the different was significant in the clinical fracture healing (P<0.05). Com-pared with the control group, the observer group lost reduction seriously during treatment. Therefore, manipulative treatment need to be reviewed X-ray in time and adjust splints fixation tightly. According to the Gartland and Werlkey wrist function evaluation standard, in the control group,6cases were rated as excellent,12cases good,4cases fair and0case poor. And the wrist function regeneration of excellent rates was81.82%.While9cases were exc-ellent,22cases good,9cases fair and0case poor in the observer group. And the wrist function regeneration of excel lent rates was77.50%. Therefore, the two different treatments were practicable and the excellent rales of the control group were a little higher than the observer group. According to Ridit analysis, there was no significant difference in the two groups(P>0.05). ConclusionAs is known, both closed manipulative reduction and small splints fixation and open reduction and Volar plate and screw fixation were the main methods to be chosen to treat Cooney II or Cooney III distal radius fracture at present. They had little effect on the fracture healing time and the adverse events However, in this research it was showed that it was much easier to lose red-uction when patients failed to promptly adjust splints at the process of fr-acture healing. According to the Gartland and Werlkey wrist function eval-uation standard, there was no significant difference in the wrist function Regeneration when all the patients were bone healing8months later. Either closed manipulative reduction and small splints fixation or open reduction and Volar approach plate and screw fixation surgery had its advantages and disadvantages. In correct clinical choice, it had to take the professional level of the doctor, medical conditions at the hospital and wrist functional requirements of the patients into consideration seriously. |
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